Parálisis unilateral aislada del nervio oculomotor común posterior a trauma craneoencefálico leve / Isolate unilateral oculomotor palsy after mild traumatic brain injury

La parálisis aislada del nervio oculomotor común (NOC) es una presentación clínica infrecuente del traumatismo craneoencefálico (TCE) leve. Escasas son las descripciones de casos en los que se ha podido demostrar el daño aislado del NOC por avulsión de las raíces con lesión axonal traumática y microhemorragia intraneural. Presentamos el caso de una paciente de 23 años que posterior a TCE leve inició con ptosis palpebral derecha, diplopía binocular y fotofobia. Al examen clínico se apreció una oftalmoparesia completa del III par craneal derecho, sin otras alteraciones. Los exámenes de neuroimagen no demostraron daño estructural compresivo sobre el NOC afectado. Se realizó resonancia magnética (RM) con ECO de gradiente y T1 contrastado. Demostrándose signos de hemorragia intraneural del NOC derecho, además de lesión axonal traumática desde su origen en el pedúnculo cerebral derecho hasta alcanzar la fisura orbitaria. Protocolos específicos de RM contribuyen a evidenciar lesiones aisladas del NOC

Isolated traumatic oculomotor nerve (ON) palsy is an uncommon clinical presentation of mild traumatic brain injury (TBI). There are very few cases in which it has been possible to demonstrate the isolated damage of the ON by avulsion of the roots, accompanied with traumatic axonal injury and intraneural microhemorrhage. We present a 23-year-old female who, after mild TBI, began to experience right ptosis, binocular diplopia, and photophobia. Clinical examination showed a complete ophthalmoparesis of the right ON, without other neurological deficits. Neuroimaging studies demonstrated no structural compressive damage of the right ON. Magnetic resonance imaging (MRI) with Gradient-echo and T1 weighted post-gadolinium was made, demonstrating signs of intraneural hemorrhage of the right ON, in addition to traumatic axonal injury extending from the right cerebral peduncle to the orbital fissure. Specific MRI protocols contribute as evidence of an isolated lesion to the ON

Isolate unilateral oculomotor palsy after mild traumatic brain injury. / Parálisis unilateral aislada del nervio oculomotor común posterior a trauma craneoencefálico leve.

Isolated traumatic oculomotor nerve (ON) palsy is an uncommon clinical presentation of mild traumatic brain injury (TBI). There are very few cases in which it has been possible to demonstrate the isolated damage of the ON by avulsion of the roots, accompanied with traumatic axonal injury and intraneural microhemorrhage. We present a 23-year-old female who, after mild TBI, began to experience right ptosis, binocular diplopia, and photophobia. Clinical examination showed a complete ophthalmoparesis of the right ON, without other neurological deficits. Neuroimaging studies demonstrated no structural compressive damage of the right ON. Magnetic resonance imaging (MRI) with Gradient-echo and T1 weighted post-gadolinium was made, demonstrating signs of intraneural hemorrhage of the right ON, in addition to traumatic axonal injury extending from the right cerebral peduncle to the orbital fissure. Specific MRI protocols contribute as evidence of an isolated lesion to the ON.