The purpose of our educational exhibit is to: outline the different categories of diseases encountered in patients with ophthalmoplegia (OP), based on their location along the oculomotor pathways and the most appropriate respective imaging strategies; cover basic anatomical and clinical concepts about OP, helping in understanding its pathophysiology; provide the neuroradiologist with the necessary knowledge to discuss clinical cases with the referring clinician.

A variety of diseasescan cause OP. They include benign, self-limiting conditions, but also serious diseases up to potentially lethal emergencies. Diseases affecting ocular movement can be divided into categories including injuries or diseases of the cerebral hemispheres, midbrain, pons and cerebellum, ocular motor nerve palsies, intrinsic extra-ocular muscles (EOMs) diseases and orbital diseases secondarily affecting EOMs. The cranial nerves (CNs) responsible for ocular movements can be affected intrinsically or extrinsically along their nuclei, their course in the brainstem, in the cisterns, skull base, cavernous sinuses...

The neuroimaging of OP should include the whole efferent visual pathways, from the cortical impulses to the orbit (Fig. 1). We can schematically classify anatomical sites that could be involved in OP on the basis of the oculomotor cranial nerves’ nuclei into: supranuclear nuclear and internuclear infranuclear (cisternal, skull base, cavernous sinus, orbit) Generally speaking, neuroimaging of OP rests on the use of CT and MR imaging techniques. In selected cases conventional catheter digital subtraction angiography (DSA) is also necessary. MR is the single most...

OP can have numerous etiologies and varying clinical presentations. Most causes of this condition can be narrowed to specific anatomical locations based on clinical data. By understanding the pathophysiology of OP, the radiologist can discuss clinical cases with the referring clinician and determine a timely, accurate method of imaging, achieving the most precise differential diagnosis.

Chou KL, Galetta SL, Liu GT, et al. Acute ocularmotor mononeuropathies: prospective study of the roles of neuroimaging and clinical assessment. J Neurol Sci 2004;219(12):35–39. Murchison AP, Gilbert ME, Savino PJ. Neuroimaging and acute ocular motor mononeuropathies: a prospective study. Arch Ophthalmol 2011;129(3):301–305. Pedersen RA, Troost BT. Abnormalities of gaze in cerebrovascular disease. Stroke; a journal of cerebral circulation 1981;12:251-4. Finocchi C, Del Sette M, Croce R, Giberti L, Serrati C, Gandolfo C. Bilateral ophthalmoplegia: an unusual sign of the top of the basilar artery...