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Recurrent isolated oculomotor nerve palsy after radiation of a mesencephalic metastasis. Case report and mini review.

Grabau O, Leonhardi J, Reimers CD - Front Neurol (2014)

Bottom Line: Recurrent oculomotor nerve palsies are extremely rare clinical conditions.The episodic palsies were probably caused by an ipsilateral mesencephalic metastasis of a breast carcinoma and occurred after successful brain radiation therapy.While the pathogenic mechanism remains unclear, the recurrent sudden onset and disappearance of the palsies and their decreasing frequency after antiepileptic treatment suggest the occurrence of epilepsy-like brainstem seizures.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Zentralklinik Bad Berka , Bad Berka , Germany.

ABSTRACT

Introduction: Recurrent oculomotor nerve palsies are extremely rare clinical conditions.

Case report: Here, we report on a unique case of a short-lasting recurrent unilateral incomplete external and complete internal oculomotor nerve palsy. The episodic palsies were probably caused by an ipsilateral mesencephalic metastasis of a breast carcinoma and occurred after successful brain radiation therapy.

Discussion: While the pathogenic mechanism remains unclear, the recurrent sudden onset and disappearance of the palsies and their decreasing frequency after antiepileptic treatment suggest the occurrence of epilepsy-like brainstem seizures. A review of case reports of spontaneous reversible oculomotor nerve palsies is presented.

No MeSH data available.


Related in: MedlinePlus

Top: T1-weighted gadolinium-enhanced axial and coronal magnetic resonance images before brain radiation therapy: lesions on the left side of the mesencephalon (left, thin arrow) in the left thalamus (right, thick arrow); bottom: corresponding images after therapy presenting much less clear lesions.
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Figure 1: Top: T1-weighted gadolinium-enhanced axial and coronal magnetic resonance images before brain radiation therapy: lesions on the left side of the mesencephalon (left, thin arrow) in the left thalamus (right, thick arrow); bottom: corresponding images after therapy presenting much less clear lesions.

Mentions: The female patient suffered from advanced stage breast carcinoma pT1cG3pN1, initially diagnosed 15 years ago, with metastases of the liver, soft tissues, and bone that had been treated with the administration of numerous chemotherapeutics, radiation, and chemoembolization. Finally, she developed cerebral metastases and meningeal carcinomatosis diagnosed by lumbar puncture presenting 115 leukocytes/μl (normal: ≤4/μl), increased protein content of 850 mg/l (normal: 150–450 mg/l), reduced glucose concentration of 1.8 mmol/l (normal: 2.2–4.4 mmol/l), high lactate concentration of 9.4 mmol/l (normal: 1.2–2.1 mmol/l), as well as tumor cells (Papanicolaou group V). Several supratentorial intra-cerebral contrast-enhancing lesions, which were most prominent left-sided in the mesencephalon with a diameter of 8 mm and in the left thalamus (Figure 1), were present on magnetic resonance images (MRI). Assuming the presence of cerebral metastases, a palliative radiation of the brain with 30.0 gray was performed. In addition, three cycles of 15 mg methotrexate were administered intrathecally through a Rickham reservoir.


Recurrent isolated oculomotor nerve palsy after radiation of a mesencephalic metastasis. Case report and mini review.

Grabau O, Leonhardi J, Reimers CD - Front Neurol (2014)

Top: T1-weighted gadolinium-enhanced axial and coronal magnetic resonance images before brain radiation therapy: lesions on the left side of the mesencephalon (left, thin arrow) in the left thalamus (right, thick arrow); bottom: corresponding images after therapy presenting much less clear lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109435&req=5

Figure 1: Top: T1-weighted gadolinium-enhanced axial and coronal magnetic resonance images before brain radiation therapy: lesions on the left side of the mesencephalon (left, thin arrow) in the left thalamus (right, thick arrow); bottom: corresponding images after therapy presenting much less clear lesions.
Mentions: The female patient suffered from advanced stage breast carcinoma pT1cG3pN1, initially diagnosed 15 years ago, with metastases of the liver, soft tissues, and bone that had been treated with the administration of numerous chemotherapeutics, radiation, and chemoembolization. Finally, she developed cerebral metastases and meningeal carcinomatosis diagnosed by lumbar puncture presenting 115 leukocytes/μl (normal: ≤4/μl), increased protein content of 850 mg/l (normal: 150–450 mg/l), reduced glucose concentration of 1.8 mmol/l (normal: 2.2–4.4 mmol/l), high lactate concentration of 9.4 mmol/l (normal: 1.2–2.1 mmol/l), as well as tumor cells (Papanicolaou group V). Several supratentorial intra-cerebral contrast-enhancing lesions, which were most prominent left-sided in the mesencephalon with a diameter of 8 mm and in the left thalamus (Figure 1), were present on magnetic resonance images (MRI). Assuming the presence of cerebral metastases, a palliative radiation of the brain with 30.0 gray was performed. In addition, three cycles of 15 mg methotrexate were administered intrathecally through a Rickham reservoir.

Bottom Line: Recurrent oculomotor nerve palsies are extremely rare clinical conditions.The episodic palsies were probably caused by an ipsilateral mesencephalic metastasis of a breast carcinoma and occurred after successful brain radiation therapy.While the pathogenic mechanism remains unclear, the recurrent sudden onset and disappearance of the palsies and their decreasing frequency after antiepileptic treatment suggest the occurrence of epilepsy-like brainstem seizures.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Zentralklinik Bad Berka , Bad Berka , Germany.

ABSTRACT

Introduction: Recurrent oculomotor nerve palsies are extremely rare clinical conditions.

Case report: Here, we report on a unique case of a short-lasting recurrent unilateral incomplete external and complete internal oculomotor nerve palsy. The episodic palsies were probably caused by an ipsilateral mesencephalic metastasis of a breast carcinoma and occurred after successful brain radiation therapy.

Discussion: While the pathogenic mechanism remains unclear, the recurrent sudden onset and disappearance of the palsies and their decreasing frequency after antiepileptic treatment suggest the occurrence of epilepsy-like brainstem seizures. A review of case reports of spontaneous reversible oculomotor nerve palsies is presented.

No MeSH data available.


Related in: MedlinePlus