Atypical presentation and behavior of oculomotor schwannoma: case report and literature review.
- 1Department of Neurosurgery and Interventional Neuroradiology, American Hospital 3, Tirana, Albania.
- 2University Hospital Center Mother Teresa, Tirana, Albania.
Abstract
Introduction
Oculomotor nerve schwannomas are rare, particularly in children. Recurrent painful oculomotor palsy may resemble recurrent painful ophthalmoplegic neuropathy (RPON), creating diagnostic uncertainty when an enhancing lesion is present along the nerve.Research question
How should recurrent painful oculomotor palsy be interpreted in a child with a persistent enhancing cisternal lesion, and how can longitudinal observation inform individualized management?Materials and methods
We report a patient who presented at 13 years of age with painful right oculomotor palsy and a focal enhancing cisternal lesion. The diagnosis was a radiologically diagnosed oculomotor nerve schwannoma; histological confirmation was not obtained. A narrative literature review contextualizes the clinical course and management, with a descriptive comparison of 14 previously reported patients with recurrent or intermittent symptoms.Results
During the initial episode, ptosis resolved over approximately four weeks following corticosteroid treatment. A second episode in 2022 resolved spontaneously. At the September 2025 assessment, ptosis was absent, but right pupillary dysfunction persisted. MRI demonstrated no reported interval change over approximately six years. Clinical improvement was not accompanied by radiological regression.Discussion and conclusion
The persistent focal lesion and its anatomical relationship to the symptomatic nerve favored a radiological diagnosis of schwannoma, although localized inflammatory neuropathy could not be definitively excluded. Observation may be reasonable in selected patients with stable lesions, acceptable neurological function, and reliable follow-up. This single case does not establish the superiority or general safety of conservative management.
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BibTeX
@article{leka2026atypical,
title = {{Atypical presentation and behavior of oculomotor schwannoma: case report and literature review.}},
author = {Vojsava Leka and Aida Agastra and Stela Dodaj and Mirel Grada and Klarisa Prenga and Arben Rroji and Eugen Enesi and Mentor Petrela},
journal = {Brain \& spine},
year = {2026},
month = oct,
doi = {10.1016/j.bas.2026.107471},
url = {https://europepmc.org/article/MED/42927262},
note = {CC BY},
}
RIS
TY - JOUR
TI - Atypical presentation and behavior of oculomotor schwannoma: case report and literature review.
AU - Vojsava Leka
AU - Aida Agastra
AU - Stela Dodaj
AU - Mirel Grada
AU - Klarisa Prenga
AU - Arben Rroji
AU - Eugen Enesi
AU - Mentor Petrela
PY - 2026
DA - 2026/10/15
JO - Brain & spine
DO - 10.1016/j.bas.2026.107471
UR - https://europepmc.org/article/MED/42927262
AB - Introduction Oculomotor nerve schwannomas are rare, particularly in children. Recurrent painful oculomotor palsy may resemble recurrent painful ophthalmoplegic neuropathy (RPON), creating diagnostic uncertainty when an enhancing lesion is present along the nerve.Research question How should recurrent painful oculomotor palsy be interpreted in a child with a persistent enhancing cisternal lesion, and how can longitudinal observation inform individualized management?Materials and methods We report a patient who presented at 13 years of age with painful right oculomotor palsy and a focal enhancing cisternal lesion. The diagnosis was a radiologically diagnosed oculomotor nerve schwannoma; histological confirmation was not obtained. A narrative literature review contextualizes the clinical course and management, with a descriptive comparison of 14 previously reported patients with recurrent or intermittent symptoms.Results During the initial episode, ptosis resolved over approximately four weeks following corticosteroid treatment. A second episode in 2022 resolved spontaneously. At the September 2025 assessment, ptosis was absent, but right pupillary dysfunction persisted. MRI demonstrated no reported interval change over approximately six years. Clinical improvement was not accompanied by radiological regression.Discussion and conclusion The persistent focal lesion and its anatomical relationship to the symptomatic nerve favored a radiological diagnosis of schwannoma, although localized inflammatory neuropathy could not be definitively excluded. Observation may be reasonable in selected patients with stable lesions, acceptable neurological function, and reliable follow-up. This single case does not establish the superiority or general safety of conservative management.
SN - 2772-5294
ER -