Neuroma as a cause of oculomotor palsy in infancy and early childhood.
BACKGROUND
Third nerve palsy in infancy and early childhood is rare. We present 5 children with isolated monocular oculomotor palsy originally believed to be idiopathic but subsequently documented to be secondary to a presumed neuroma of the third nerve, distal to the mesencephalon.


METHODS
Retrospective case review of patient charts from 1995 through 1999 was performed.


RESULTS
Mean age at initial presentation was 14.4 months (range, 2-36 months). Two patients were male. Initial manifestation was an incomplete paresis in all 5 cases; 2 patients presented initially with exotropia, 2 with ptosis, and 3 with anisocoria. The pupil was ultimately involved in all cases. Progression to total paresis occurred in 4 of 5 patients over a mean of 13 months (range, 4-22 months). Findings of initial neuroimaging were believed to be normal in all cases but further thin-section gadolinium-enhanced magnetic resonance imaging studies, including coronal views, revealed enlargement and/or enhancement of the subarachnoid or intracavernous portion of the oculomotor nerve. Aberrant regeneration did not develop in any case throughout follow-up (mean, 49.4 months). Visual acuity was decreased on the ipsilateral side in all cases, consistent with amblyopia. No patient had neurofibromatosis.


CONCLUSIONS
Suspicion for neuroma should be high in infants and young children with acquired, isolated, apparently idiopathic third nerve palsy. Serial gadolinium-enhanced, 1- to 2-mm thin-section magnetic resonance imaging with coronal views is essential for proper diagnosis.
Norman
A A
AA
Dean A. McGee Eye Institute, University of Oklahoma, Department of Ophthalmology, Oklahoma City 73104, USA.
Farris
B K
BK
Siatkowski
R M
RM
D002675:Child, Preschool; D003390:Cranial Nerve Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009463:Neuroma / Q000150:complications* / Q000175:diagnosis; D015840:Oculomotor Nerve Diseases / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D014792:Visual Acuity