Bilateral third-nerve palsy with aberrant regeneration in Guillain-Barré syndrome

Bilateral oculomotor synkinesis following Miller Fisher syndrome

A 64-year-old female presented with ptosis, ophthalmoplegia, ataxia, and weakness. She was diagnosed with Miller Fisher syndrome (MFS) and was treated with plasmapheresis. Six months later, she developed bilateral oculomotor synkinesis, suggesting aberrant regeneration. The pathogenesis of MFS is reviewed in light of this unusual finding.

Infranuclear ocular motor disorders

This chapter covers the very large number of possible disorders that can affect the three ocular motor nerves, the neuromuscular junction, or the extraocular muscles. Conditions affecting the nerves are discussed under two major headings: those in which the site of damage can be anatomically localized (e.g., fascicular lesions and lesions occurring in the subarachnoid space, the cavernous sinus, the superior orbital fissure, or the orbit) and those in which the site of the lesion is either nonspecific or variable (e.g., vascular lesions, tumors, "ophthalmoplegic migraine," and congenital disorders). Specific comments on the diagnosis and management of disorders of each of the three nerves follow. Ocular motor synkineses (including Duane's retraction syndrome and aberrant regeneration) and disorders resulting in paroxysms of excess activity (e.g., neuromyotonia) are then covered, followed by myasthenia gravis and other disorders that affect the neuromuscular junction. A final section discusses disorders of the extraocular muscles themselves, including thyroid disease, orbital myositis, mitochondrial disease, and the muscular dystrophies.

Selected lid problems in neurologic practice

Ptosis is a common clinical finding. The many causes of ptosis include involutional (aging), myopathic, neuropathic, congenital, infectious, tumorous, traumatic, and inflammatory processes. This article reviews recent literature on some causes of ptosis and other lid conditions.

Temporary bilateral oculomotor nerve palsy as the sole presenting sign of a pituitary mass

A 65-year-old patient presented with isolated bilateral third nerve palsy. Neuroimaging demonstrated a 2 cm pituitary mass with extension into the cavernous sinus on the right. The patient went on to experience spontaneous complete resolution of symptoms with associated radiological shrinkage of the mass. Bilateral third nerve palsy is a very rare presenting sign, with only one previous case reported in the literature secondary to a pituitary adenoma. Spontaneous resolution of non-functioning pituitary tumours is reported to occur in approximately 10% of cases. However, there are only a small number of reports to date involving spontaneous regression of tumours with corresponding resolution of cranial nerve palsies.