Gd-DTPA enhancement of the cisternal portion of the oculomotor nerve on MR imaging

Abstract

Purpose: To describe a radiographic finding--enhancement of the cisternal portion of the third cranial nerve on postcontrast MR--and to correlate it with patients' clinical symptoms and ultimate diagnosis.

Materials and methods: Thirteen consecutive patients with enhancement of the cisternal portion of the third cranial nerve on postcontrast MR were retrospectively identified; 50 control patients referred for pituitary microadenomas were also retrospectively reviewed.

Findings: The enhancement was bilateral in six patients and unilateral in seven patients. Four of the six patients with bilateral enhancement had unilateral oculomotor nerve palsies; none had bilateral third cranial nerve palsy. Five of the seven patients with unilateral enhancement had ipsilateral third nerve palsies. Of the nine patients with third nerve palsies, the pupil was involved in four patients. Follow-up studies were available in six patients, four of whom had third nerve palsy. Resolution of the enhancement correlated with resolution of the symptoms in two patients. The patients' underlying diagnoses were lymphoma (four), leukemia (one), viral meningitis (one), neurofibromatosis (two), inflammatory polyneuropathy-HIV related (one), ophthalmoplegic migraine (one), Tolosa-Hunt syndrome (one), coccidioidomycosis (one), and diabetes (one). No enhancement was seen in any of the controls.

Conclusion: Enhancement of the cisternal segment of the third cranial nerve is always abnormal, revealing an underlying inflammatory or neoplastic process. However, it is not always associated with clinically apparent oculomotor nerve dysfunction.