Travmatik İzole Tek Taraflı Okülomotor Sinir Felcinin Acil Serviste Yönetimi ve Literatür Taraması

Year 2022, , 340 - 344, 30.06.2022

Volkan Ülker , Sami Olkaç , Necip Gökhan Guner , Yusuf Yurumez

https://doi.org/10.31832/smj.925663

Abstract

Kraniyal sinir lezyonları konjenital, enfeksiyöz, neoplastik oluşumlar, migren ve kafa travmasına bağlı olarak görülmektedir. Hastanın yaşı ile birlikte klinik bulgular ve nöroradyolojik görüntüleme çalışmaları tanıya rehberlik eder. Araba kazası nedeniyle Ambulans tarafından acil servise getirilen 57 yaşında kadın hastayı sunduk. Hastanın bilinçi açık, oryante ve koopereydi. Vitaller normaldi. Hastanın muayenesinde; sol gözde pitozis, direk ışık refleksinde kayıp, medial hareketlerinde kısıtlılık ve midriyazis belirlendi. Radyolojik görüntülemeler normal olarak değerlendirildi. Hasta izole 3. kraniyal sinir felci tanısıyla izlem amaçlı yatırıldı. İzole 3. kraniyal sinir felci genellikle majör travmaya ikincil nadir bir durumdur. Buna ek olarak, herhangi bir nörogörüntüleme anormalliği kanıtı olmaksızın izole tek taraflı 3. kraniyal sinir felci olabilir. Hastanın şikayetleri ile detaylı nörolojik muayene ve klinik takip yapması gereken bu tür durumlarda acil hekimleri yönlendirici muayene bulgularına dikkat etmelidir.

Keywords

Acil Servis, İzole okülomotor Sinir Felci, Midriyazis, Minör Kafa Travması

Management of Traumatic Isolated Unilateral Oculomotor Nerve Palsy in the Emergency Department and Literature Review

Abstract

Cranial nerve (CN) lesions are observed due to congenital, infectious, neoplastic formations, migraine and head trauma. Along with the patient's age, clinical findings and neuroradiological imaging studies guide the diagnosis. A 57-year-old female patient was brought to the emergency room (ER) by Emergency Medical Services (EMS) due to a motor vehicle accident. No medical history. She was conscious, cooperative and orientated. Vital findings were normal. She had ptosis in the left eye, loss in the direct light reflex, restricted medial movements and mydriasis were determined. Radiological examination is normal. The patient was hospitalized with the diagnosis of isolated 3rd cranial nerve palsy (OCNP). Isolated OCNP is a rare condition usually secondary to major trauma. In addition to, there may be isolated unilateral OCNP without any evidence of neuroimaging abnormality. Emergency physicians should be vigilant in such cases that should perform detailed neurological examination and clinical follow-up for the patient's complaints.

Keywords

Emergency Department, Isolated Oculomotor Nerve Palsy, Minor Head Trauma, Mydriasis

References

• Referans 1-) Sung-HyunLee, Sang-SooLee, Kye-YeonPark, Seol-HeuiHan. Isolated oculomotor nerve palsy: diagnostic approach using the degree of external and internal dysfuntion. Clinical Neurology and Neurosurgery, 2002 May, Volume 104, Issue 2, Pages 136-141
• Referans 2-) Ealmaan Kim, Hyukwon Chang. Isolated oculomotor nerve palsy following minor head trauma: Case illustration and literature review. J Korean Neurosurg Soc. 2013 Nov; 54(5): 434–436.
• Referans 3-) Ali Kemal Erenler, Anıl Yalçın, Ahmet Baydin. Isolated unilateral oculomotor nerve palsy due to head trauma. Asian J Neurosurg. 2015 Jul-Sep; 10(3): 265–267.
• Referans 4-) Bruce BB1, Biousse V, Newman NJ. Third nerve palsies. Semin Neurol. 2007 Jul;27(3):257-68.
• Referans 5-) Najafi MR, Mehrbod N. Isolated third nerve palsy from mild closed head trauma. Arch Iran Med 2012;15:583‑4.
• Referans 6-) Avinash Mishra, Somesh Aggarwal, Nitin Vichare, Anirudh Singh. Isolated unilateral oculomotor nerve palsy following a mild head injury. Med J Armed Forces India. 2015 Dec; 71(Suppl 2): S620–S623.
• Referans 7-) Lin C, Dong Y, Lv L, Yu M, Hou L. Clinical features and functional recovery of traumatic isolated oculomotor nerve palsy in mild head injury with sphenoid fracture. J Neurosurg. 2013 Feb;118:364e369.