Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Acknowledgements
Authors’ reply
Book Review
Book Reviews
Classics In Indian Medicine
Clinical Case Report
Clinical Case Reports
Clinical Research Methods
Clinico-pathological Conference
Clinicopathological Conference
Conferences
Correspondence
Corrigendum
Editorial
Eminent Indians in Medicine
Errata
Erratum
Everyday Practice
Film Review
History of Medicine
HOW TO DO IT
Images In Medicine
Indian Medical Institutions
Letter from Bristol
Letter from Chennai
Letter From Ganiyari
Letter from Glasgow
Letter from London
Letter from Mangalore
Letter From Mumbai
Letter From Nepal
Masala
Medical Education
Medical Ethics
Medicine and Society
News From Here And There
Notice of Retraction
Notices
Obituaries
Obituary
Original Article
Original Articles
Review Article
Selected Summaries
Selected Summary
Short Report
Short Reports
Speaking for Myself
Speaking for Ourselve
Speaking for Ourselves
Students@nmji
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Acknowledgements
Authors’ reply
Book Review
Book Reviews
Classics In Indian Medicine
Clinical Case Report
Clinical Case Reports
Clinical Research Methods
Clinico-pathological Conference
Clinicopathological Conference
Conferences
Correspondence
Corrigendum
Editorial
Eminent Indians in Medicine
Errata
Erratum
Everyday Practice
Film Review
History of Medicine
HOW TO DO IT
Images In Medicine
Indian Medical Institutions
Letter from Bristol
Letter from Chennai
Letter From Ganiyari
Letter from Glasgow
Letter from London
Letter from Mangalore
Letter From Mumbai
Letter From Nepal
Masala
Medical Education
Medical Ethics
Medicine and Society
News From Here And There
Notice of Retraction
Notices
Obituaries
Obituary
Original Article
Original Articles
Review Article
Selected Summaries
Selected Summary
Short Report
Short Reports
Speaking for Myself
Speaking for Ourselve
Speaking for Ourselves
Students@nmji
View/Download PDF

Translate this page into:

Images In Medicine
2020:33:5;313-313
doi: 10.4103/0970-258X.317463
PMID: 34213466

Cyclic oculomotor palsy in a young male

Adarsh Shashni, Pradeep Sharma, Nripen Gaur, Swati Phuljhele
 Dr R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Corresponding Author:
Pradeep Sharma
Dr R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
India
drpsharma57@yahoo.com
Published: 02-Jun-2021
How to cite this article:
Shashni A, Sharma P, Gaur N, Phuljhele S. Cyclic oculomotor palsy in a young male. Natl Med J India 2020;33:313
Copyright: (C)2020 The National Medical Journal of India

A 16-year-old male presented with complaints of drooping of the upper eyelid of the right eye with outward and downward deviation of the eye with poor vision since birth. He had no systemic illness. Two phases of clinical findings were noted. In the paralytic phase (40–50 seconds), the patient had complete ptosis along with the presence of anisocoria with the right eye pupil of 5 mm and left eye pupil of 3 mm. There was an exotropia and hypotropia in the right eye. In the spastic phase (10–12 seconds), there was a resolution of ptosis, anisocoria and eye deviation [Figure - 1]. Based on these clinical findings, a diagnosis of cyclic third cranial nerve palsy was made.

Figure 1: Right eye oculomotor palsy in the paralytic phase characterized by ptosis, exotropia with hypotropia (A); oculomotor palsy in the spastic phase characterized by resolution of ptosis and hypotropia (B); right eye infrared pupillometry shows dilated pupil in the paralytic phase (C); right eye infrared pupillometry shows pupillary constriction in the spastic phase (D).

Cyclic oculomotor palsy was first reported by Rampoldi.[1] It is characterized by a paralytic phase which may be complete or partial third cranial palsy and a spastic phase characterized by constriction of the pupil along with improvement of ptosis and strabismus.

Loewenfeld and Thompson have proposed that there is some insult in the form of trauma or infectious aetiology occurring at an early age of development resulting in damage to the intracranial portion of the third cranial nerve resulting in damage to the nucleus.[2] The damaged nucleus may recover partially resulting in abnormal connection with both central and peripheral target tissues. These abnormal cells are thought to be responsible for the cyclic nature of the entity where the summation of sub-threshold impulses to threshold levels occurs which are then discharged periodically.[2]

Conflicts of interest. None declared

References
1.
Rampoldi R. Casuistica clinica. II. Singolarissiom caso di equilibrio motorio oculopalpebrale. Ann Ottalmo 1884;13:463–9.
[Google Scholar]
2.
Loewenfeld IE, Thompson HS. Oculomotor paresis with cyclic spasms. A critical review of the literature and a new case. Surv Ophthalmol 1975;20:81–124.
[Google Scholar]

Fulltext Views
1,611

PDF downloads
666
Show Sections