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Contribution of MRI in cases of isolated mydriasis: description of neurovascular conflicts.
Author(s) -
TRECHOT F,
BRAUN M,
CLOCHE V,
ANGIOI K
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.t124.x
Subject(s) - mydriasis , medicine , neurovascular bundle , anisocoria , diplopia , oculomotor nerve palsy , pupil , ptosis , oculomotor nerve , palsy , ophthalmology , radiology , surgery , pathology , psychology , alternative medicine , neuroscience
Purpose To study the contribution of MRI (sequence FIESTA) in the analysis of isolated and persistant mydriasis. Methods Prospective single center study (November 2010 to March 2012) including patients with unilateral mydriasis (pure intrinsic Cranial Nerve III palsy) without life‐threatening pathology. Complete ophthalmological, systemic and neurological examinations were performed. All patients with any symptoms of extrinsic CN III palsy (diplopia, ptosis or ophthalmoplegia), with tonic pupil (pilocarpine diluted test positive), use of toxic or drug taking, sign of focus at neurological examination have been excluded. Our patients underwent cerebral MRI: images acquisition were performed on a GE 3T MRI, protocol included FIESTA and 3D TOF sequences. Results Five patients were included (20 to 41 years), 2 women. They presented with a single non reactive, isolated and persistent mydriasis with a pilocarpine diluted‐test negative. For all, an obvious relationship between CN III and its adjacent Posterior Comunicating Artery (PCA) was demonstrated through FIESTA sequences with MPR images (3 real neurovascular conflicts in Root Entry Zone, 1 before cavernous sinus, 1 compression between PCA and dorsum selae). No saccular aneuvrysm or tumors were found. Conclusion Thanks to MRI, we explained the symptoms for all the five patients, because of anatomical features, including neurovascular conflicts. If it has been described previously for facial and trigeminal nerves, no neurovascular conflict between CN III and PCA has been demonstrated before. The contribution of MRI in the study of anisocoria seems to be considered, and could help for diagnostic of a pathology tagged idiopathic.