| OCR Text |
Show Letters to the Editor Downloaded from http://journals.lww.com/jneuro-ophthalmology by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 05/10/2022 3. Rao A, Shah S, Sim B, Yun S, Jain N, Kalani MY, Francis IC. Neuroradiological endovascular intervention for diplopia in a case of aneurysmal aberrant regeneration of the third nerve. Cureus 2017;9:e1340. 4. Anan M, Nagai Y, Fudaba H, Kubo T, Ishii K, Murata K, Hisamitsu Y, Kawano Y, Hori Y, Nagatomi H, Abe T, Fujiki M. Third nerve palsy caused by compression of the posterior communicating artery aneurysm does not depend on the size of the aneurysm, but on the distance between the ICA and the anterior–posterior clinoid process. Clin Neurol Neurosurg. 2014;123:169–173. 5. Yan SY, Peng YJ, Lin CS, Peng GS, Chang PY. Isolated oculomotor nerve palsy as a paraneoplastic manifestation of gastric diffuse large B-cell lymphoma: a case report. Oncol Lett. 2014;8:1983–1985. 6. O'Day J, Billson F, King J. Ophthalmoplegic migraine and aberrant regeneration of the oculomotor nerve. Br J Ophthalmol. 1980;64:534–536. 7. Iaconetta G, de Notaris M, Cavallo LM, Benet A, Enseñat J, Samii M, Ferrer E, Prats-Galino A, Cappabianca P. The oculomotor nerve: microanatomical and endoscopic study. Neurosurgery. 2010;66:593–601. 8. Ling MLH, Tynan D, Ruan CW, Lau FS, Spencer SKR, Agar A, Francis IC. Assessment of saccadic velocity at the bedside. Neuroophthalmology 2020;44:71–75. Oculomotor Palsy Due to Malignant Nerve Sheath Tumor: Aberrant Regeneration of the Third Nerve but Without Pupil Involvement: Response abduction was detected in the left eye. The patient had complete ophthalmoplegia, and the velocity of the abducting saccade could not be assessed. Considering there was complete ophthalmoplegia and no torsion of the left eye in any direction (including with attempted downgaze), the fourth nerve was also involved in this case. Regarding involvement of the first sensory branch of the trigeminal nerve, the patient did have mild decreased sensation in that distribution on the left, with associated decreased left corneal sensation. We agree with the likelihood that the left sympathetic pathways were at least partially affected as well, given the ipsilateral mid-dilated nonreactive pupil. We appreciate the author's interest in our report, but aberrant regeneration of CN3 was not demonstrably present in our patient. W e would like to thank Toohey et al for their interest in our case report. In Figure 2, they note that the examiner's finger elevates the eyelid in all positions except when the patient looks up and to the right and indicate that they believe there is elevation of the left upper eyelid when the patient looks up and to the right. They go on to suggest that aberrant regeneration of the third cranial nerve (CN3) was present, specifically left eyelid retraction in adduction. We reviewed the figure in question and our original examination photographs and we did not detect any significant difference in the size of the palpebral fissure between left and right gaze. We include here an additional set of photographs without the examiner's hand in the frame to support this so that there is no confusion (Fig. 1). The examiner's finger was not elevating the eyelid when the patient looked up, up and right, and up and left. Rather, it was simply positioned in front of the brows in the upper frames of the figure holding the patient's head steady and making sure there was no brow overaction during testing of the extraocular movements. The patient's head did slightly turn right when he looked up and right, and this may be contributing to their observation. Toohey et al also reported that they noticed a minimal amount of abduction of the left eye. We reviewed the original photographs and our examination report and no Jonathan A. Micieli, MD, CM Department of Ophthalmology and Vision Sciences and Medicine (Neurology), University of Toronto, Toronto, Canada Nancy J. Newman, MD Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia The authors report no conflicts of interest. FIG. 1. External photographs demonstrating no significant change in the size of the left palpebral fissure in right and left gaze. 140 Letters to the Editor: J Neuro-Ophthalmol 2021; 41: 135-140 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
