MRI Findings of Oculomotor Nerve Palsy in Mild Traumatic Brain Injury: Case Report and Review of the Literature

Abstract

Isolated traumatic oculomotor nerve palsy associated with mild traumatic brain injury (TBI) is rarely reported in literature and has not been associated with magnetic resonance imaging (MRI) findings until this case report. We report the case of a 55-year-old man with complete left side traumatic oculomotor nerve palsy, 7 mm non-reactive dilated pupil, and ptosis after a helmeted bicycle accident. Mild sulcal subarachnoid hemorrhage was seen on computed tomography (CT) at presentation. MRI during hospitalization showed contrast enhancement of the cisternal segment of the left oculomotor nerve, near the rootlets as it exits the brainstem. He was followed for 18 months with near resolution of oculomotor nerve palsy, but persisting enhancing lesion on MRI at the third nerve outlet from the brainstem, suggestive of partial avulsion. Isolated oculomotor nerve palsy after mild TBI is extremely rare. After review of the literature, we are the first to show radiographic evidence of injury to the oculomotor nerve in a patient with mild TBI. MRI studies may be helpful in a patient with isolated oculomotor nerve palsy to identify the type of injury to the nerve, to rule out underlying pathology concurrent with the TBI, and may also indicate prognosis for recovery.




J Neurol Res. 2013;3(5):163-165
doi: https://doi.org/10.4021/jnr233w