Ghimire Sagun, Shrestha Shikher, Shrestha Dinuj, Ranabhat Kajan, Bhattarai Suman, Bhandari Kritick, Kc Rikesh
Department of Neurosurgery, B and B Hospital.
Department of Radiology, B and B Hospital.
Ann Med Surg (Lond). 2024 Aug 30;86(10):6251-6256. doi: 10.1097/MS9.0000000000002514. eCollection 2024 Oct.
When compared to other cranial nerve palsies idiopathic unilateral oculomotor nerve palsy with pupillary sparing is one of the least noted neurological conditions. Moreover, there lies a series of diagnostic dilemmas to come into a final diagnosis resulting in several array of clinical investigations. Hence, there is a delay in prompt management.
An elderly female without any known comorbidities presented with the complaint of headache, dizziness and dropping of left eyelid. Several arrays of diagnostic workups was done to come to a diagnosis, but even with rigorous laboratory investigations and radiological examinations, a common working diagnosis could not be made. Hence with a diagnosis of exclusion after proper neurological and neuro-ophthalmological examination, idiopathic unilateral common oculomotor nerve palsy was identified for which improvement with steroids was noted in the patient.
Idiopathic unilateral complete oculomotor nerve palsy is considered as a diagnosis of exclusion when all the diagnostic parameters fail to signify and positive results. The vague symptomatic presentation of the disease condition further compels the treating physician to carry out several panels of laboratory to radiological investigations. But if identified in time the treatment modality is straightforward.
The diagnostic quandary in timely identification of such disease conditions needs a pertinent diagnostic guideline so as to avoid the unwanted panel of investigations.
与其他颅神经麻痹相比，伴有瞳孔保留的特发性单侧动眼神经麻痹是最不常见的神经系统疾病之一。此外，在做出最终诊断时存在一系列诊断难题，这导致了一系列临床检查。因此，及时治疗会有所延迟。
一名无任何已知合并症的老年女性，主诉头痛、头晕和左眼睑下垂。为了做出诊断进行了一系列诊断检查，但即使经过严格的实验室检查和影像学检查，仍无法做出常见的初步诊断。因此，在进行了适当的神经学和神经眼科检查后，通过排除诊断，确定为特发性单侧动眼神经麻痹，患者使用类固醇后症状有所改善。
当所有诊断参数均未显示阳性结果时，特发性单侧完全性动眼神经麻痹被视为排除性诊断。该疾病模糊的症状表现进一步迫使治疗医生进行从实验室检查到影像学检查的多组检查。但如果能及时识别，治疗方式很简单。
及时识别此类疾病时的诊断困境需要相关的诊断指南，以避免不必要的检查项目。
