NR 3-4/2002
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Urazowe obrażenia nerwu okoruchowego
Traumatic injures oculomotor nerve
Zofia Mariak1, Radosław Żywalewski1, Lech
Zimnoch2, Jerzy Janica3
1Z Kliniki Okulistyki Akademii Medycznej w Białymstoku
Kierownik: dr hab. n. med. Zofia Mariak
2Z Zakładu Anatomii Patologicznej Akademii Medycznej w Białymstoku
Kierownik: prof. dr hab. n. med. Stanisław Sulkowski
3Z Zakładu Medycyny Sądowej Akademii Medycznej w Białymstoku
Kierownik: prof. dr hab. n. med. Jerzy Janica |
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| Summary: |
Purpose of the study: A collective summary
of the pathogenesis, character and clinical significance of damage to the oculomuscular
innervation, arising from closed head trauma, based on our own clinical observations,
together with a review of literature on the topic.
Materials and methods: The clinical and pathophysiological evaluation of
injuries to the oculomotor (III) nerve based on a prospective study in our clinic, dating
from 1994 onwards:
- the clinical material consisted of 600 patients admited to our Department of
Neurosurgery following head trauma,
- the subgroup consisted of 38 patients, who died following major head trauma.
Results: Few authors focus on damage to the innervation of oculomotor
muscles, the diagnosis of damage being difficult due to the usually poor clinical conditon
of such patients, the interdisciplinary nature of the resulting damage, and their delayed
opthalmological evaluation. The oculomotor (III) nerve is the nerve most frequently
damaged amongst the cranial nerves, taking into account the innervation of the ocular
system nerves (II-VII). Of clinical importance is differentiating between the mechanism of
damage, paying particular attention to intracranial damage. The mechanisms of damage can
be distuinguished by: 1) partial tearing of the parasympathetic fibres contused against
the petroclinoid ligament, 2) total tearage of the parasympathetic nerve root, 3) complete
tear of one or both oculomotor nerves at the interpeduncular base, 4) nerve root tear,
resulting from vessel perforation. The oculomotor nerve has the ability to regenerate. The
regenerative process should occur within 3 to 5 months, that is without pathological
synkinesis. If this processs prolongs, this may lead to unpleasant consenquences, such as
the "misdirection phenomen".
Conclusions: Primary damage to the oculomuscular innervation resulting
from closed head trauma is an integral component of such conditions. Early diagnosis and
neuroprotective therapy may prevent pathological regeneration. |
| Słowa kluczowe: |
nerw okoruchowy, zamknięty uraz głowy. |
| Key words: |
oculomotor nerve, closed head injury. |
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