2020 Volume 43 Issue 2 Pages 61-64
We report on a rare case of isolated oculomotor nerve palsy in association with an epidural hematoma. A 67–year–old female was involved in a bicycle accident and hit the temporal side of her head. She experienced loss of consciousness for several minutes but was awake and oriented on admission. Computed tomography (CT) showed a left temporal bone fracture and a 4 × 3 × 3 cm acute epidural hematoma in the middle fossa. Left intra– and extraocular muscle impairment appeared several hours later. The epidural hematoma did not progress on CT and was managed conservatively. After 8 days, her left pupil shrunk slightly and response to light began to appear. Eighteen days later, the pupillary light reflex recovered and visual acuity and ocular fundus were normal. However, anisocoria of about 1 mm and ptosis remained. Restriction of eye movement was not evident on manual inspection, but the Hess screen test revealed an adduction disturbance of the left eye. Thirty days later, computed tomography revealed that the hematoma had resolved. Magnetic resonance imaging performed 2 months later demonstrated no new lesion. The ptosis had improved but diplopia subjectively remained.
The cause of her symptoms in this case was considered to be compression of the oculomotor nerve near the superior orbital fissure by the temporal lobe, secondary to an expanded epidural hematoma. The oculomotor nerve palsy had improved 2 months later with conservative treatment alone. A comparison of the recovery process between surgical treatment and conservative management need further study.
