Occulomotor Nerve Palsy Causes and Clinical Features
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3rd cranial nerve
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Occulomotor Nerve Palsy Causes and Clinical Features
- 6. Frontal lobe Temporal lobe Sphenoid sinus Optic chiasma 3 4 6 5- Opthalmic 5- Maxillary
- 16. Weber’s Syndrome -corticospinal (pyramidal) tract -contralateral hemiparesis. Benedict’s Syndrome -Red nucleus -contralateral hemitremor Nothnagel’s Syndrome - -involves the superior cerebellar peduncle -cerebellar ataxia Claude’s Syndrome - Nothnagel’s + Benedict’s syndrome.
- 18. first indication of altered consciousness
- 19. Microvaslular abnormality like DM / HTN -Transient 3 rd nerve palsy -Pupilary sparing
- 20. Berry anurysm at posterior communicating artery -Headache -Neck stifness -Vomiting -Pupilary dilatation
- 22. Subarachnoid lesion -Basal meningeal infection -Inflamation -Neoplastic infilteration With multiple cranial nerve palsy
- 23. Frontal lobe Temporal lobe Sphenoid sinus Optic chiasma 3 4 6 5- Opthalmic 5- Maxillary Cavernous sinus lesion -affect multiple cranial nerve -involve also 4th and 6th nerve so difficult to differentiate clinically -differentiated by involvement of 5th nerve by pain and numbness in forehead and cheek,
- 24. Fracture of orbital wall would also lead 3rd nerve palsy
- 25. Local pathology of orbit Also lead to isolated &/or partial 3rd nerve palsy Which may be associated with -Prptosis -conjuctival congetion -chemosis -pain on movement
- 26. ABERRANT REGENERATION OF OCULOMOTOR NERVE • follows damage of the nerve by trauma or tumor. Lid gaze dyskinesis • Elevation of the lid on adduction (inverse Duane’s sign) • Elevation of the lid on depression (pseudo Von Graffe’s sign). Pupil gaze dyskinesis • Constriction on adduction (pseudo Argyll Robertson pupil) • Constriction on depression. Without a preceding third nerve palsy usually is caused by a cavernous sinus tumor or aneurysm. aberrant regeneration never occurs in Ischemic III nerve palsy
- 27. Mx • OCCLUTION • MEDICAL – multivitamin injections • Sx – • Potsis – silicon sling • Squint sx – to achive alignment but not functioning • Tenotomy of the lateral rectus and the superior oblique combined with a transposition of the vertical recti muscles to the insertion of the medial rectus muscle • Partial palsy with slight medial rectus movement one can perform a maximal recession of the lateral rectus muscle (at least 12 mm) and resection of the medial rectus (at least 7 mm) with upward transposition of the tendons in case of an associated hypotropia
- 28. CASE • 3YR F CHILD • c/o inability to open RE – 2 month • h/o fever (15 days) followed by epilepsy 2.5 month back -diagnosed TB MENINGITIS - MT + -ADA 24.3 CT BRAIN – infarct –rt basal ganglion - rt cerebral peduncle -rt midbrain -rt dosromedial temporal lobe
Editor's Notes
- In midbrain-at level of SUPERIOR COLLICULUS- ventromedial grey matter-surroinding aqueduct10 mm length
- Accesory motor nucleas– E-W…send preganglionicpaasympathatic.Light reflex & accomodation reflex.FASCICULAR PART
- BASILAR PART FROM ROOTLETS form nerve.Get TWISTEDPass btwnSUPRIOR CEREBELLAR & POST CEREBRAL.Parallel to post communicating ..
- PERIPHERAL PARASYMP GANGLIONAt Apex of orbit- btwn Optic N & tendon of LR
- NUCLEAR LESION— 1) SR fibres are supplied by CL 3RD NUCLEAS 2) BL LPS are supplied by central CAUDAL NUCLEAS.
- FASICULAR SYNDROMS
- supratentorialspaceoccupyingmass located anywhere in or above this cerebralHemispheredownward displacement and herniation ofthe uncus across the tentorial edge, thereby compressing the thirdnerve.