[Pubmed] Ophthalmoplegia Caused by Non-Aneurysm Neurovascular Conflict: Clinical Cases of Eight Patients

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Rev Neurol. 2026 Mar 12;81(3):47615. doi: 10.31083/RN47615.

ABSTRACT

BACKGROUND: Neurovascular conflict (NVC) is a rare but often overlooked cause of oculomotor cranial nerve (OCN) palsy. In this study, we aimed to enhance understanding of NVC as a potential cause of cranial nerve palsies by summarizing the characteristics of eight OCN palsy cases associated with NVC and reviewing previously reported cases.

METHODS: A retrospective case series of eight patients with OCN palsy due to NVC was analyzed. Diagnosis was made using 3.0 Tesla magnetic resonance imaging (MRI) with 3D-fast imaging with steady-state acquisition (3D-FIESTA) sequences. Differential diagnoses like myasthenia gravis, inflammatory diseases, and aneurysms were excluded.

RESULTS: The study involved eight patients (six males, two females), aged 34-78 years (average 58.4 years). Six had abducens nerve palsy, and two had partial oculomotor nerve palsy, all exhibiting painless partial ophthalmoplegia. Imaging revealed OCN compression by various arteries: abducens nerve palsy was due to the basilar artery (three patients), vertebral artery (one patient), and anterior inferior cerebellar artery (two patients); two cases of partial oculomotor nerve palsy were caused by compression of the superior cerebellar artery and the posterior cerebral artery, respectively.

CONCLUSION: NVC should be considered in patients with abducens nerve palsy, particularly those with intermittent symptoms and painless ophthalmoplegia, especially if they have atherosclerotic risk factors; in this descriptive single-center cohort, diagnosis was supported by high-resolution MRI, including 3D-FIESTA and magnetic resonance angiography.

PMID:41914338 | DOI:10.31083/RN47615


Source: https://pubmed.ncbi.nlm.nih.gov/4191433 ... t6+133c1fe