Successful steroid pulse therapy for acute unilateral oculomotor nerve palsy associated with norovirus infection
Kuki, I.; Kawawaki, H.; Okazaki, S.; Ikeda, H.; Tomiwa, K.
No to Hattatsu 40(4): 324-327
2008
ISSN/ISBN: 0029-0831 PMID: 18634419 Document Number: 619814
We report a 4-year-old boy who developed acute unilateral oculomotor nerve palsy following Norovirus infection. He visited our hospital because of diplopia three weeks after Norovirus gastroenteritis. Physical examination showed only the left oculomotor nerve palsy. Enhanced MRI of the brain and cerebrospinal fluid examination revealed no abnormality. Anti GQIb antibody was negative. Because blepharoptosis and ophthalmoplegia progressed rapidly. We performed three courses of steroid pulse therapy (methylpredonisolone 30mg/kg x 3 day/course) combined with vitamin B-6. Autonomic dysfunction (isocorea, light reflex) began to improve in several days and subsequently extraocular movements (blepharoptosis. infraduction supraduction, adducent in order) resolved completely in one month. Idiopathic oculomotor paralysis is usually believed to be selflimited, but steroid pulse therapy should to be considered in cases ocular paralysis is so severe or progressive that immune-mediated mechanism was presumed.