Other complaints were decreased level of consciousness, decreased vision, vomiting, hearing loss, acromegalic features, numbness, proptosis, cerebrospinal fluid (CSF) rhinorrhoea, altered behaviour, ataxia, blindness, dysphagia, oculomotor nerve
palsy, diplopia, vertigo, monoplegia, post-auricular discharge and tinnitus.
Ptosis may be caused by trauma to the levator muscle, insult to the superior cervical sympathetic ganglion or damage to the oculomotor nerve
Because the trochlear nerve lies in close vicinity to the oculomotor nerve
at the lateral wall of the cavernous sinus, these two cranial nerves are generally involved together.
Orbital apex syndrome (OAS) has been described as a syndrome involving damage to the oculomotor nerve
(CN3), trochlear nerve (CN4), ophthalmic branch of the trigeminal nerve (CN5) and abducens nerve (CN6) in association with optic nerve dysfunction.
The supraorbital keyhole approach effectively exposes the frontal lobe base, anterior clinoid process, canalis opticus, olfactory sulcus, olfactory tract, optic nerve, optic chiasm, oculomotor nerve
, anterior communicating artery, anterior cerebral artery A1 segment, pituitary stalk, diaphragma sellae, dorsum sellae, posterior clinoid process, basilar artery apex, posterior cerebral artery P1 segment, superior cerebellar artery proximal, front upper pontine and interpeduncular cistern, anteromedial temporal lobe, internal carotid, middle cerebral artery (M1, M2 segment, and part of M3 segment), anterior choroidal artery, posterior communicating artery; and contralateral carotid artery medial surface, anterior cerebral artery A1 and A2 proximal, middle cerebral artery M1 and M2 proximal.
The combination of ptosis, ipsilateral pupillary dilation, and lack of response to light is a manifestation of oculomotor nerve
disorder (SLATTER, 2005).
Complete neuroophthalmic examination included the visual acuity test, color vision test, visual field analysis (Goldman), pupillary reaction test, oculomotor nerve
test, Hertel exophthalmometry, and ophthalmoscopy of ocular fundus.
Hyperglycemia and the eventual ischemic occurrence stemming from diabetic macroangiopathic changes have been postulated as the most common causes of the cranial nerve palsies especially the oculomotor nerve
injury developed after a head injury is present in about 2,9% of cases (6).
A 37-year-old woman presented with isolated right-sided oculomotor nerve
There may also be oculomotor nerve
palsy ipsilateral to the lesion, which may be partial (unilateral pupil dilatation).
Melkersson-Rosenthal syndrome with partial oculomotor nerve