Rare occurrence of a transient isolated unilateral partial third nerve palsy after angioplasty.

To cite: Vasavada A, Parekh P, Agrawal N, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201826 DESCRIPTION We report a rare case of isolated unilateral partial oculomotor nerve palsy in an elderly woman a day after radial angioplasty presenting with diplopia and ptosis. A 65-year-old woman with diabetes and hypertension presented with the acute onset transient partial third cranial nerve palsy presenting as diplopia and ptosis after 1 day of undergoing a double vessel angioplasty which spontaneously improved after a day of its occurrence. The patient was in normal sinus rhythm and there was no echocardiographic evidence of any thrombus in the left-sided cardiac chambers. An ocular examination revealed ptosis with paresis of the muscles supplied by the oculomotor nerve with down and out cornea and mild mydriasis (figures 1–3). There was no other motor or sensory deficit suggestive of a cerebrovascular accident (CVA) or evidence of facial palsy or Horner’s syndrome. MRI of the brain carried out subsequently was normal with no evidence of a CVA or cavernous sinus thrombosis. The patient was managed conservatively. The symptoms improved spontaneously after 2 days and the patient was subsequently discharged on dual antiplatelet therapy as per the recommendations for patients after angioplasty. The occurrence of oculomotor palsy after angioplasty has never been described before and the most plausible hypothesis for its occurrence could be a transient CVA caused by a lacunar infarct which was too small to be picked up on MRI involving the third nerve nuclei. Another hypothesis could be could be an oculomotor involvement as seen in patients with diabetes. It could also have been a transient inflammatory or immune response to contrast or an occulomotor palsy similar to that known to happen after neurosurgery. lastly it could have been just a coincidental occurrence of the illness after the procedure.