Pupil-Sparing Inferior Divisional Palsy of Third Cranial (Oculomotor) Nerve in Tolosa-Hunt Syndrome

Abstract

Pupil-sparing inferior divisional oculomotor nerve palsy is rare and has not been described in Tolosa-Hunt syndrome (THS). A 24-year-old man with right supraorbital pain and binocular vertical diplopia for 2 weeks underwent full neuro-ophthalmolgical evaluations including brain magnetic resonance imaging (MRI). The patient showed right exo- and hypertropia with impaired depression and adduction of the right eye. The pupils were normal. Other findings of neurological examination and brain MRI were normal. The headache and ophthalmoplegia improved within 2 days of corticosteroid treatment. In view of the pupil sparing, the patient may have a lesion selectively involving the shorter branch of the oculomotor inferior division in the orbit. THS may manifest with pupil-sparing inferior divisional oculomotor palsy.

Keywords::

• diplopia
• oculomotor nerve
• Tolosa-Hunt syndrome

ACKNOWLEDGEMENTS

This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (A080750).

Declaration of interest: Dr. Nam report no conflict of interest. Dr. Kim, corresponding author, serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Korean Society of Clinical Neurophysiology, Research in Vestibular Science, Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, and Journal of Neuro-ophthalmology; and received research support from SK Chemicals, Co. Ltd.