Overview of ophthalmoplegia
Nuclear ophthalmoplegia (nuclear ophthalmoplegia), oculomotor nerve nuclear lesions often involve neighboring structures, such as the abducens nerve nuclear damage often involves the facial nerve; the subnucleus of the oculomotor nerve is many and scattered, the lesion only involves part of the nucleus at an early stage so that part of the eye muscles are involved or the extraocular muscles and pupillary muscle damage is separated, but can also involve both sides. It is common in brainstem vascular disease, inflammation and tumor lesions. The best time for treatment is within 3 months of onset.
Etiology
Ocular motility disorders caused by damage to the oculomotor nerve nuclei, such as the nucleus of the oculomotor, gliding, and abducens nerves, due to vascular disease, inflammation, and tumors in the brainstem.
Differential diagnosis
Nuclear oculomotor palsy is similar to peripheral oculomotor palsy in terms of clinical manifestations, but has the following 3 features.
1. Bilateral eye movement disorder
The nucleus accumbens is close to the midline, and the lesion often involves part of the nucleus accumbens bilaterally, resulting in bilateral ocular motility disorders.
2. Damage to neighboring structures in the brainstem
Lesions of the nucleus accumbens often damage the facial nerve fibers surrounding the nucleus accumbens, resulting in ipsilateral peripheral facial nerve palsy and involvement of the trigeminal nerve and the pyramidal tract, resulting in trigeminal nerve palsy and contralateral hemiparesis.
3. Dissociative ophthalmoplegia
Nuclear oculomotor palsy can be manifested as selective damage to individual nerve nuclei. For example, if there are many subnuclei of the nucleus accumbens and scattered, the lesion may only involve part of these nuclei and cause one eye muscle to be involved, while the other eye muscles will not be affected, which is known as detached oculomotor palsy.
Examination
Ophthalmologic examination and routine examination.
Principles of treatment
The best treatment time for ophthalmoplegia is within 3 months from the onset of the disease, and the earlier the better.