Abstract
Ipsilateral third nerve palsy with early pupillary enlargement is an important sign of transtentorial herniation from a supratentorial mass lesion. A case of frontal, intraparenchymal haemorrhage is reported in which the first ocular manifestation of transtentorial herniation was enlargement of the contralateral pupil. The ipsilateral pupil dilated only after complete oculomotor palsy of the contralateral eye. After partial frontal lobectomy and removal of blood clot, the ipsilateral third nerve recovered before the contralateral third nerve. Clinical findings localised the contralateral third nerve lesion to an extra-axial site. The possible mechanisms of contralateral third nerve compression are discussed. This seems to be the first example of pupillary enlargement as a false localising sign from a contralateral, supratentorial, intraparenchymal mass lesion.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- GASSEL M. M. False localizing signs. A review of the concept and analysis of the occurrence in 250 cases of intracranial meningioma. Arch Neurol. 1961 May;4:526–554. doi: 10.1001/archneur.1961.00450110056007. [DOI] [PubMed] [Google Scholar]
- JENNETT W. B., STERN W. E. Tentorial herniation, the mid brain and the pupil. Experimental studies in brain compression. J Neurosurg. 1960 Jul;17:598–609. doi: 10.3171/jns.1960.17.4.0598. [DOI] [PubMed] [Google Scholar]
- PEVEHOUSE B. C., BLOOM W. H., McKISSOCK W. Ophthalmologic aspects of diagnosis and localization of subdural hematoma. An analysis of 389 cases and review of the literature. Neurology. 1960 Nov;10:1037–1041. doi: 10.1212/wnl.10.11.1037. [DOI] [PubMed] [Google Scholar]
- Ropper A. H. The opposite pupil in herniation. Neurology. 1990 Nov;40(11):1707–1709. doi: 10.1212/wnl.40.11.1707. [DOI] [PubMed] [Google Scholar]
- SUNDERLAND S. The tentorial notch and complications produced by herniations of the brain through that aperture. Br J Surg. 1958 Mar 18;45(193):422–438. doi: 10.1002/bjs.18004519306. [DOI] [PubMed] [Google Scholar]