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    <div class="highwire-article-citation highwire-citation-type-highwire-article node11925--5" data-node-nid="11925" id="top-node-11925--61420199645" data-pisa="ajnr;33/5/E78" data-pisa-master="ajnr;ajnr.A3130" data-apath="/ajnr/33/5/E78.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Oculomotor Nerve Enhancement after Mild Head Trauma</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E. Anagnostou</span>, <span class="highwire-citation-author" data-delta="1">S. Vassilopoulou</span>, <span class="highwire-citation-author" data-delta="2">K. Spengos</span> and <span class="highwire-citation-author" data-delta="3">S. Lachanis</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2012,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E78; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3130 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-11925--61420199645" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E. Anagnostou </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BAnagnostou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Anagnostou%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.%2BAnagnostou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S. Vassilopoulou </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BVassilopoulou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vassilopoulou%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BVassilopoulou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">K. Spengos </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BSpengos%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Spengos%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK.%2BSpengos%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">S. Lachanis </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BLachanis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lachanis%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BLachanis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><p id="p-1">A 32-year-old woman presented with vertical diplopia after a blunt head injury due to a vehicle crash. On examination 2 weeks after the trauma, she had a pupil-involving right third-nerve palsy. The absence of intorsion when looking downward starting from an abducted eye-in-orbit position suggested a concomitant fourth nerve palsy. T1-weighted brain MR imaging revealed marked gadolinium enhancement of the cisternal portion of the right oculomotor nerve (<a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1</a>). The trochlear nerve could not be visualized on the available scans.</p><div id="F1" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/33/5/E78/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Transverse and coronal T1-weighted images before (left) and after (middle and right) administration of gadolinium diethylene triamine pentaacetic acid. The cisternal segments of both oculomotor nerves are readily visible exiting the midbrain. Marked contrast enhancement appears in the right oculomotor nerve (arrows)." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-1944758851" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Transverse and coronal T1-weighted images before (left) and after (middle and right) administration of gadolinium diethylene triamine pentaacetic acid. The cisternal segments of both oculomotor nerves are readily visible exiting the midbrain. Marked contrast enhancement appears in the right oculomotor nerve (&lt;em&gt;arrows&lt;/em&gt;).&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/33/5/E78/F1.medium.gif" width="440" height="120"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/33/5/E78/F1.medium.gif" width="440" height="120"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/33/5/E78/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/33/5/E78/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/37973" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 1.</span> 
<p id="p-2" class="first-child">Transverse and coronal T1-weighted images before (left) and after (middle and right) administration of gadolinium diethylene triamine pentaacetic acid. The cisternal segments of both oculomotor nerves are readily visible exiting the midbrain. Marked contrast enhancement appears in the right oculomotor nerve (<em>arrows</em>).</p>
<div class="sb-div caption-clear"></div></div></div><p id="p-3">Mechanical compression and/or traction of cranial nerves may develop as a consequence of head trauma. Still, systematic studies of cranial nerve palsies after mild head injury are sparse. In a recent analysis by Coello et al,<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> 11.3% of patients with posttraumatic cranial nerve injuries had an oculomotor nerve palsy; 42.8% of these patients had at least 1 additional cranial nerve involvement. The most commonly associated nerve injury was to the trochlear nerve. Unfortunately, no MR imaging data are available from this study.</p><p id="p-4">Oculomotor nerve enhancement is not uncommon in inflammatory conditions and in ophthalmoplegic migraine.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> On the other hand, the presence of cranial nerve enhancement after head injury is not systematically investigated. We could find only 1 case description of nerve enhancement after a presumed mild head injury concerning the hypoglossal nerve.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> Despite the lack of data in the clinical literature, contrast enhancement of injured nerves after traction or compression is well-known from animal experiments.<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Neuropathologic findings indicate that the intraneural edema caused by mechanical compression is a vasogenic edema induced by congesting venous blood flow and develops because of increased permeability of capillaries in the endoneurial space. In turn, leakage of endoneurial pressure appears to induce demyelination.<sup><a id="xref-ref-4-2" class="xref-bibr" href="#ref-4">4</a></sup> Our case presents pathologic gadolinium enhancement of the third cranial nerve after a minor head injury, which probably reflects a trauma-induced local breakdown of the blood-nerve barrier, with consequent edema formation. Modern MR imaging techniques such as 3D constructive interference in steady state<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup> may help develop diagnostic algorithms for monitoring and treatment of cranial nerve palsies after head injury.</p><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.5.E78.1" data-doi="10.3171/2010.6.JNS091620"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Coello</span>  <span class="cit-name-given-names">AF</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Canals</span>  <span class="cit-name-given-names">AG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gonzalez</span>  <span class="cit-name-given-names">JM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Cranial nerve injury after minor head trauma</span>. <abbr class="cit-jnl-abbrev">J Neurosurg</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">113</span>:<span class="cit-fpage">547</span>–<span class="cit-lpage">55</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3171/2010.6.JNS091620&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=20635856&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F5%2FE78.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.5.E78.2"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Mark</span>  <span class="cit-name-given-names">AS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Blake</span>  <span class="cit-name-given-names">P</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Atlas</span>  <span class="cit-name-given-names">SW</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Gd-DTPA enhancement of the cisternal portion of the oculomotor nerve on MR imaging</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">1992</span>;<span class="cit-vol">13</span>:<span class="cit-fpage">1463</span>–<span class="cit-lpage">70</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIxMy81LzE0NjMiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMzMvNS9FNzguYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.5.E78.3" data-doi="10.1111/j.1552-6569.2010.00498.x"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Sakushima</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Terae</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Tsuji-Akimoto</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Idiopathic hypoglossal nerve laceration detected by high-resolution three-dimensional constructive interference in steady state magnetic resonance imaging</span>. <abbr class="cit-jnl-abbrev">J Neuroimaging</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">21</span>:<span class="cit-fpage">e177</span>–<span class="cit-lpage">79</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1111/j.1552-6569.2010.00498.x&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=20572910&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F5%2FE78.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.5.E78.4"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kobayashi</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Meir</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Baba</span>  <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Imaging of intraneural edema by using gadolinium-enhanced MR imaging: experimental compression injury</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">973</span>–<span class="cit-lpage">80</span></cite></div><div class="cit-extra"></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2012 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2012, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E78; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3130 </span></div>
  
  
  
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