Cavernous Sinus Mass Causing Right 3rd and 4th Nerve Palsies

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Identifier 3rd_with_4th_involved
Title Cavernous Sinus Mass Causing Right 3rd and 4th Nerve Palsies
Alternative Title Video 4.18 Cavernous sinus mass causing ipsilateral 3rd and 4th nerve palsies from Neuro-Ophthalmology and Neuro-Otology Textbook
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Third (Oculomotor) Nerve Palsy; ThirdSsubnuclear; Fourth (Trochlear) Nerve Palsy
Description 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 25-yo-man who complained of diplopia and was initially found to have right 4th and 6th nerve palsies in the setting of a right cavernous sinus mass (subsequently diagnosed as Ewing's sarcoma). When seen in follow-up (this video), there was a new right 3rd nerve palsy, still with a right 4th nerve palsy, and improved 6th nerve palsy. Video shows right 3rd and 4th nerve palsies (very mild 6th nerve palsy too) in the setting of a right cavernous sinus syndrome. In downgaze OD, there is no clear incyclotorsion of the eye, suggesting that the right 4th nerve is involved. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This patient had a known right cavernous sinus mass due to Ewing's sarcoma, and presented with diplopia. He had a right 3rd NP, right 4th NP, and mild right 6th NP. This video demonstrates that in addition to the right 3rd (ptosis, mydriasis, impaired adduction, supra- and infraduction), in downgaze, there is no clear incycloduction of the right eye, suggesting that the right 4th nerve is also involved. This is a subtle sign, but should be sought since a 3rd NP + an ipsilateral 4th NP is suggestive of a cavernous sinus localization. https://collections.lib.utah.edu/ ark:/87278/s6186g5w
Date 2016
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6186g5w
Setname ehsl_novel_gold
ID 187725
Reference URL https://collections.lib.utah.edu/ark:/87278/s6186g5w
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