PMC5309438_01
Computed tomography and magnetic resonance imaging. CT and MRI examinations demonstrate no abnormal findings. No intracranial hemorrhage (a) and no basilar fracture (b) are apparent in axial CT images on day 1. An axial heavy T2-weighted MRI image (c) shows the left oculomotor nerve running over the posterior petroclinoid ligament and no apparent damage to the nerve on day 7. No aneurysm is visible in MR angiography (d)
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F1
The neurological exam and CT was normal [Figure 1]. CT, magnetic resonance imaging (MRI), and MR angiography showed no abnormal findings [Figure 1].
Photographs of the patient's extraocular movements. (a) right supraduction; (b) supraduction; (c) left supraduction; (d) right lateral gaze; (e) mid-position; (f) left lateral gaze; (g) right infraduction; (h) infraduction; (i) left infraduction
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F2
However, he had noticed drooping of his left eyelid and double vision with onset on the second day; subsequent examination revealed an isolated left oculomotor nerve palsy with a nonreactive pupil [Figures 2-4]. Over the next 3 months, the ptosis and ocular motility resolved fully, however, the left pupil was still larger and less reactive to light than the right [Figures 2 and 3].
Hess chart on day 1 (a), and 3 months after injury (b)
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F3
However, he had noticed drooping of his left eyelid and double vision with onset on the second day; subsequent examination revealed an isolated left oculomotor nerve palsy with a nonreactive pupil [Figures 2-4]. Over the next 3 months, the ptosis and ocular motility resolved fully, however, the left pupil was still larger and less reactive to light than the right [Figures 2 and 3].
Photograph of the right (a) and left pupil (b) on day 1, and right (c) and left pupil (d) 3 months after injury
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F4
However, he had noticed drooping of his left eyelid and double vision with onset on the second day; subsequent examination revealed an isolated left oculomotor nerve palsy with a nonreactive pupil [Figures 2-4].