Ocular Motor Nerve Palsies in Children

Pediatric Cranial Nerve Palsies

“…The SO muscle also accounts for the small hypotropia seen with CN III palsies. 1 Oculomotor nerve palsies can also occur in partial forms in which there is limitation without complete absence of ocular elevation, depression, and/or adduction and variable amounts of upper lid ptosis and pupillary dilation.…”

“…The differential diagnosis of pediatric oculomotor nerve palsy includes myasthenia gravis, orbital blowout fracture, Duane syndrome, internuclear ophthalmoplegia, and congenital fibrosis of the extraocular muscles (CFEOM). 1 Often the history and clinical examination can help differentiate oculomotor nerve palsy from the aforementioned etiologies. Myasthenia gravis does not affect the pupil and often presents with variable strabismus and ptosis that worsens throughout the day.…”

“…Nothnagel syndrome is a CN III palsy and cerebellar ataxia, localizing the lesion to the midbrain in the region of the brachium conjunctivum. 1 Benedikt syndrome consists of a CN III palsy with contralateral hemidyskinesia and localizes the lesion in the red nucleus. Weber syndrome is a CN III palsy with contralateral hemiplegia, localizing the midbrain lesion to the cerebral peduncle.…”

“…Weber syndrome is a CN III palsy with contralateral hemiplegia, localizing the midbrain lesion to the cerebral peduncle. 1 The oculomotor nerve leaves the midbrain and enters the subarachnoid space between the posterior cerebral artery and the superior cerebellar artery. In this space, the third nerve is susceptible to trauma from a basilar skull fracture, compression secondary to aneurysms involving the posterior communicating artery, and compression secondary to transtentorial herniation of the brain as it passes along the free edge of tentorium.…”

“…In this space, the third nerve is susceptible to trauma from a basilar skull fracture, compression secondary to aneurysms involving the posterior communicating artery, and compression secondary to transtentorial herniation of the brain as it passes along the free edge of tentorium. 1 The pupillary fibers are the most superficial in the oculomotor nerve; therefore pupillary dilation may be one of the first signs of compression of the nerve.…”