J Korean Ophthalmol Soc.  2015 Aug;56(8):1300-1303. 10.3341/jkos.2015.56.8.1300.

A Case of Isolated Third Nerve Palsy with Preeclampsia

• Lee JH
• Wi YJ
• Choi YJ

• KMID: 2215087
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1300

Abstract

PURPOSE
Isolated oculomotor nerve palsy in preeclampsia patients have not been reported in Korea. Herein, we report 1 case of a patient in her 32nd week of gestation diagnosed with preeclampsia experiencing oculomotor nerve palsy in the left eye which improved after delivery.
CASE SUMMARY
28-year-old pregnant woman in her 32nd week of gestation with no underlying diseases visited our clinic with the chief complaint of diplopia and left eye ptosis. The patient suffered headache symptoms 1 week prior and did not undergo any exams. The visual acuity, anterior segment, and, fundus showed no abnormal signs and the pupil light reflex was normal, but the patient showed left eye ptosis with +2 mm/-2 mm on the marginal reflex distance (MRD) exam, 25 prism exotropia and 6 prism hypotropia, supraduction and adduction limitation -2 and, infraduction limitation -1. To exclude other systemic disorders and brain lesions, laboratory tests and brain magnetic resonance imaging (MRI) was performed, and preeclampsia was diagnosed based on high blood pressure (150/110 mm Hg) and mild proteinuria. Imaging and labatory tests showed other disorders thus the patient was treated conservatively. Two weeks after the ocular symptoms appeared, the left ptosis and ocular movement restriction worsened, but systemic signs and tests shown no aggravation, thus we maintained conservative therapy and after delivery at 37-weeks, the symptoms slowly improved and recovered completely after 2 months.
CONCLUSIONS
Full systemic examination including MRI and laboratory tests must be performed in pregnant women who suddenly experience ocular symptoms and are diagnosed as oculomotor motor nerve palsy. If diagnosis and treatment are appropriate, good prognosis can be expected in this disease.

Keyword

Oculomotor nerve palsy; Preeclampsia; Third nerve palsy

MeSH Terms

Adult
Brain
Diagnosis
Diplopia
Exotropia
Female
Headache
Humans
Hypertension
Korea
Magnetic Resonance Imaging
Oculomotor Nerve Diseases*
Paralysis
Pre-Eclampsia*
Pregnancy
Pregnant Women
Prognosis
Proteinuria
Pupil
Reflex
Visual Acuity

Figure

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  Figure 1. Changes after progress of left eye ptosis in oculomo-tor nerve palsy. (A) First onset of symptoms; patient shows mild ptosis. (B) After 2 weeks; ptosis gets aggravated and shows complete ptosis. (C) Recovery of ptosis after 2 months of delivery.

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  Figure 2. Eye movement photo in first visit. Patient showed supraduction and adduction limitationGrade -2, infraduction limitation Grade -1.

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  Figure 3. After 2 weeks, eye movement restriction got agg- ravated to adduction limi-tation grade -4, supraduction limitation grade -3.5, infra- ductionlimitation grade -2.

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  Figure 4. Full recovery of eye movement and ptosis after 2 months of delivery.

Reference

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