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Mydriasis revealing vascular and osteodural compression of the oculomotor nerve: An observational study on five cases.
J Fr Ophtalmol. 2016 Jun; 39(6):491-7.JF

Abstract

PURPOSE

To describe a form of neurovascular compression of the third cranial nerve (CNIII) in idiopathic mydriasis, in which a neurovascular "conflict" exists between the oculomotor nerve, the posterior communicating artery and the clinoid process, using high-resolution magnetic resonance imaging (MRI) with fast imaging employing steady acquisition (FIESTA) sequences.

METHODS

An 18-month prospective, observational and monocentric case series report was performed. MRI was performed on 5 consecutive patients with idiopathic, unilateral, persistent and nonreactive mydriasis (pure intrinsic palsy of the CNIII). Patients with diplopia, ptosis or ophthalmoplegia were excluded. Cerebral MRI focused on the CNIII pathway from the mesencephalon to the cavernous sinus entry, particularly on the cisternal segment: image acquisition was performed on a 3 Tesla MRI; the protocol included fast imaging employing steady acquisition (FIESTA) and three-dimension time of flight (3D TOF) sequences.

RESULTS

All patients presented a neurovascular compression point, involving the CNIII clamped between a tortuous posterior communicating artery (PCoA) and the posterior clinoid process at the entrance of the cavernous sinus. No cases occurred in the root entry zone. There was no compression on the contralateral side. No tumors or aneurysms were found. Thus, the mydriasis was caused by CNIII compression.

CONCLUSION

MRI, including FIESTA sequences, revealed a new type of neurovascular conflict between the CNIII, PCoA and posterior clinoid process in patients with incomplete oculomotor palsy. Non-aneurysmal CNIII compression should be considered as a differential diagnosis in the work-up of idiopathic mydriasis. The role of MRI in the work-up of anisocoria should be considered.

Authors+Show Affiliations

Département d'Ophtalmologie, CHU de Nancy, hôpitaux de Brabois, , 9, allée du Morvan, 54000 Vandœuvre-lès-Nancy, France; CIC-IT IADI, unité Inserm U-947, Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France. Electronic address: fannytrechot@gmail.com.CIC-IT IADI, unité Inserm U-947, Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France; Service de Neuroradiologie, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.Département d'Ophtalmologie, CHU de Nancy, hôpitaux de Brabois, , 9, allée du Morvan, 54000 Vandœuvre-lès-Nancy, France.Service de Neuroradiologie, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.CIC-IT IADI, unité Inserm U-947, Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France; Service de Neuroradiologie, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.Département d'Ophtalmologie, CHU de Nancy, hôpitaux de Brabois, , 9, allée du Morvan, 54000 Vandœuvre-lès-Nancy, France.

Pub Type(s)

Case Reports
Journal Article
Observational Study

Language

eng

PubMed ID

27262623

Citation

Tréchot, F, et al. "Mydriasis Revealing Vascular and Osteodural Compression of the Oculomotor Nerve: an Observational Study On Five Cases." Journal Francais D'ophtalmologie, vol. 39, no. 6, 2016, pp. 491-7.
Tréchot F, Tonnelet R, Conart JB, et al. Mydriasis revealing vascular and osteodural compression of the oculomotor nerve: An observational study on five cases. J Fr Ophtalmol. 2016;39(6):491-7.
Tréchot, F., Tonnelet, R., Conart, J. B., Legou, F., Braun, M., & Angioi, K. (2016). Mydriasis revealing vascular and osteodural compression of the oculomotor nerve: An observational study on five cases. Journal Francais D'ophtalmologie, 39(6), 491-7. https://doi.org/10.1016/j.jfo.2016.03.004
Tréchot F, et al. Mydriasis Revealing Vascular and Osteodural Compression of the Oculomotor Nerve: an Observational Study On Five Cases. J Fr Ophtalmol. 2016;39(6):491-7. PubMed PMID: 27262623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mydriasis revealing vascular and osteodural compression of the oculomotor nerve: An observational study on five cases. AU - Tréchot,F, AU - Tonnelet,R, AU - Conart,J-B, AU - Legou,F, AU - Braun,M, AU - Angioi,K, Y1 - 2016/06/01/ PY - 2015/12/12/received PY - 2016/03/24/revised PY - 2016/03/29/accepted PY - 2016/6/6/entrez PY - 2016/6/6/pubmed PY - 2017/5/24/medline KW - Blessures du nerf oculomoteur KW - Mydriase KW - Mydriasis/etiology KW - Nerve compression syndromes KW - Oculomotor nerve injuries KW - Pupille tonique KW - Syndromes de compression nerveuse KW - Tonic pupil KW - Étiologie SP - 491 EP - 7 JF - Journal francais d'ophtalmologie JO - J Fr Ophtalmol VL - 39 IS - 6 N2 - PURPOSE: To describe a form of neurovascular compression of the third cranial nerve (CNIII) in idiopathic mydriasis, in which a neurovascular "conflict" exists between the oculomotor nerve, the posterior communicating artery and the clinoid process, using high-resolution magnetic resonance imaging (MRI) with fast imaging employing steady acquisition (FIESTA) sequences. METHODS: An 18-month prospective, observational and monocentric case series report was performed. MRI was performed on 5 consecutive patients with idiopathic, unilateral, persistent and nonreactive mydriasis (pure intrinsic palsy of the CNIII). Patients with diplopia, ptosis or ophthalmoplegia were excluded. Cerebral MRI focused on the CNIII pathway from the mesencephalon to the cavernous sinus entry, particularly on the cisternal segment: image acquisition was performed on a 3 Tesla MRI; the protocol included fast imaging employing steady acquisition (FIESTA) and three-dimension time of flight (3D TOF) sequences. RESULTS: All patients presented a neurovascular compression point, involving the CNIII clamped between a tortuous posterior communicating artery (PCoA) and the posterior clinoid process at the entrance of the cavernous sinus. No cases occurred in the root entry zone. There was no compression on the contralateral side. No tumors or aneurysms were found. Thus, the mydriasis was caused by CNIII compression. CONCLUSION: MRI, including FIESTA sequences, revealed a new type of neurovascular conflict between the CNIII, PCoA and posterior clinoid process in patients with incomplete oculomotor palsy. Non-aneurysmal CNIII compression should be considered as a differential diagnosis in the work-up of idiopathic mydriasis. The role of MRI in the work-up of anisocoria should be considered. SN - 1773-0597 UR - https://www.unboundmedicine.com/medline/citation/27262623/Mydriasis_revealing_vascular_and_osteodural_compression_of_the_oculomotor_nerve:_An_observational_study_on_five_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0181-5512(16)30079-1 DB - PRIME DP - Unbound Medicine ER -