Türk Beyin Damar Hast Derg. 2015; 21(2): 119-122 | DOI: 10.5505/tbdhd.2015.81300

Case report: Isolated unilateral pitosis; involvement of partial fasiculer due to midbrain infarction

Cennet Nalan Kuþ Soyder, Refik Kunt
Department of Neurology, Aydýn State Hospital, Aydýn

Ptosis could be caused by oculomotor nerve palsy in the midbrain infarction. Isolated midbrain infarction is rare. We report a patient with isolated unilateral ptosis caused by partial fascicular oculomotor paresis due to midbrain infarction. A 59-year-old woman was unable to open her right eye on waking up the morning and was admitted to our hospital. Ptosis was found in the right eye. The other examination findings were normal. In radiological imaging showed an acute infarction in the right paramedian midbrain and the lesion was compatible with localization of the right oculomotor fascicle. She was diagnosed with partial fascicular oculomotor paresis due to paramedian midbrain infarction. By administration of anti-platelet agents, ptosis was resolved within 1.5 months.

The anatomy of the third cranial nerve fascicle and its courses through the midbrain is a topic of debate. Previous reports of oculomotor fascicular infarction have elucidated the human oculomotor fascicular arrangement and from these material topographical models have been proposed. Compared to proposed models for arrangement of oculomotor fascicle, this case demonstrates that the fibers to levator palpebrae may be located in the most caudal portion of the oculomotor fascicles. The case is interesting in that the isolated ptosis due to the oculomotor fascicular palsy only involved the levator palpebrae fibers and is intended to contribute to the literature by being discussed with the oculomotor fascicles models.

Keywords: Oculomotor nevre, oculomotor fasicül, pitosis, isolated, mesencephalon infarction, anotomy.

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Olgu sunumu: Tek taraflý izole pitoz; orta beyin infarktýna baðlý parsiyel fasiküler tutulum

Cennet Nalan Kuþ Soyder, Refik Kunt
Aydýn Devlet Hastanesi Nöroloji Kliniði, Aydýn

Pitoz orta beyin infarktlarýnda okulomotor sinir paralizi nedeniyle olabilir. Ýzole orta beyin infarktlarý nadirdir. Biz bu yazýda orta beyin infarktýna baðlý parsiyel fasiküler tutulumun neden olduðu izole tek taraflý pitozu olan bir olgu bildiriyoruz. Sabah kalktýðýnda sað göz kapaðýnda düþüklük olduðunu fark eden 59 yaþýnda kadýn olgu bu yakýnma ile hastanemize baþvurdu. Nörolojik muayene sað gözde saptanan pitoz dýþýnda normaldi. Radyolojik görüntülemelerinde sað paramedian orta beyinde akut infarkt saptandý ve bu lezyon sað okulomotor fasiküllerin lokalizasyonuyla uyumluydu. Olgu orta beyin infarktýna baðlý geliþen parsiyel okulomotor fasiküler paralizi tanýsýný aldý. Antiagregan tedavi ile pitoz yaklaþýk 1.5 ay içinde düzeldi.
Üçüncü kraniyal sinirin fasiküllerinin orta beyindeki anatomisi ve seyri tartýþma konusudur. Okulomotor fasiküllerin düzeni araþtýrýlmýþ ve topografik modeller ileri sürülmüþtür. Önerilen okülomotor fasiküllerin modellerine göre levator palpebra liflerinin okülomotor fasiküllerin en kaudalinde yer aldýðýný gösterilmiþtir. Ýzole etkilenmeleri oldukça nadirdir. Olgu yalnýzca levator palpebra liflerini içeren okülomotor liflerin paralizine baðlý izole pitoz olduðu için sunulmuþtur ve okülomotor fasiküllerinin modelleri ile birlikte tartýþýlarak literatüre katkýda bulunulmasý amaçlanmýþtýr.

Anahtar Kelimeler: okülomotor sinir, okülomotor fasikül, pitoz, izole, mesensefalon infartý, anatomi.

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