Superior Divisional Third Cranial Nerve Paresis

Abstract

Background: Within the midbrain, the third nerve nucleus is composed of a complex of subnuclei. The fascicular portion of the nerve courses through the red nucleus and exists in the midbrain just medial to the cerebral peduncle. The cisternal portion of the nerve is a single structure that divides into a superior branch and an inferior branch in the region of the cavernous sinus and superior orbital fissure.Objective: To describe 2 patients with superior divisional third cranial nerve paresis resulting from a lesion involving the cisternal portion of the nerve prior to its anatomical bifurcation.Patients: Case 1 was a 77-year-old man with a superior divisional third nerve palsy as the presenting manifestation of a posterior communicating artery aneu-rysm. Case 2 was a 41-year-old woman who developed a superior divisional third nerve palsy following anterior temporal lobectomy for epilepsy. Results:In both cases, the presumed location of the lesion was the cisternal portion of the third cranial nerve.Conclusions: Although the anatomical division of the third cranial nerve occurs in the region of the anterior cavernous sinus or superior orbital fissure, there is a topographical arrangement of the motor fibers within the cisternal portion of the nerve. The clinical evaluation of a patient with a third cranial nerve paresis requires an understanding of the regional neuroanatomy and topographical organization of the nerve.

Internuclear ophthalmoplegia following radial artery cardiac catheterization approach: An unusual presentation

“…The slowed adducted eye is associated with a complete or limited range of adduction. [ 11 ] Contrary to all reports of INO, in our patient, there was no nystagmus after all angiography, and this may be the first case of INO without nystagmus.…”

Internuclear ophthalmoplegia following radial artery cardiac catheterization approach: An unusual presentation

“…The slowed adducted eye is associated with a complete or limited range of adduction. [ 11 ] Contrary to all reports of INO, in our patient, there was no nystagmus after all angiography, and this may be the first case of INO without nystagmus.…”

Inferior Divisional Oculomotor Nerve Palsy Due to Orbital Lymphoma

“… 2 This anatomic arrangement has resulted in divisional patterns of oculomotor palsy being considered a sign of a lesion involving the anterior cavernous sinus or the orbit. 3 Orbital lymphoma may present as various patterns of ophthalmoplegia, but to the best of our knowledge isolated inferior divisional oculomotor nerve palsy has not previously been described in association with orbital lymphoma. 4 5 We report a patient in whom the inferior divisional pattern of oculomotor nerve palsy in isolation guided the localization of a tiny lymphoma restricted to the inferior division of the oculomotor nerve in the orbit.…”

Surgical management of oculomotor nerve palsy – a review of the literature

“…Additionally, a lesion affecting the topographically-distributed motor fibres in the cisternal portion of the nerve could cause a divisional paresis, despite being proximal to the bifurcation. 8 Superior divisional lesions typically present with an upper eyelid ptosis and limitation of elevation on the ipsilateral side, due to the paresis of the SR and LPS muscles. 8 Inferior divisional lesions, whilst being very rare (Ing et al reported only 1 in 54 patients with OMN palsy having such a lesion 9 ), classically present with large exotropia, hypertropia and intorsion of the affected eye.…”

Internuclear ophthalmoplegia following radial artery cardiac catheterization approach: An unusual presentation

“…The slowed adducted eye is associated with a complete or limited range of adduction. [ 11 ] Contrary to all reports of INO, in our patient, there was no nystagmus after all angiography, and this may be the first case of INO without nystagmus.…”

Inferior Divisional Oculomotor Nerve Palsy Due to Orbital Lymphoma

“… 2 This anatomic arrangement has resulted in divisional patterns of oculomotor palsy being considered a sign of a lesion involving the anterior cavernous sinus or the orbit. 3 Orbital lymphoma may present as various patterns of ophthalmoplegia, but to the best of our knowledge isolated inferior divisional oculomotor nerve palsy has not previously been described in association with orbital lymphoma. 4 5 We report a patient in whom the inferior divisional pattern of oculomotor nerve palsy in isolation guided the localization of a tiny lymphoma restricted to the inferior division of the oculomotor nerve in the orbit.…”

Surgical management of oculomotor nerve palsy – a review of the literature

“…Additionally, a lesion affecting the topographically-distributed motor fibres in the cisternal portion of the nerve could cause a divisional paresis, despite being proximal to the bifurcation. 8 Superior divisional lesions typically present with an upper eyelid ptosis and limitation of elevation on the ipsilateral side, due to the paresis of the SR and LPS muscles. 8 Inferior divisional lesions, whilst being very rare (Ing et al reported only 1 in 54 patients with OMN palsy having such a lesion 9 ), classically present with large exotropia, hypertropia and intorsion of the affected eye.…”

Internuclear ophthalmoplegia following radial artery cardiac catheterization approach: An unusual presentation

“…The slowed adducted eye is associated with a complete or limited range of adduction. [ 11 ] Contrary to all reports of INO, in our patient, there was no nystagmus after all angiography, and this may be the first case of INO without nystagmus.…”

Inferior Divisional Oculomotor Nerve Palsy Due to Orbital Lymphoma

“… 2 This anatomic arrangement has resulted in divisional patterns of oculomotor palsy being considered a sign of a lesion involving the anterior cavernous sinus or the orbit. 3 Orbital lymphoma may present as various patterns of ophthalmoplegia, but to the best of our knowledge isolated inferior divisional oculomotor nerve palsy has not previously been described in association with orbital lymphoma. 4 5 We report a patient in whom the inferior divisional pattern of oculomotor nerve palsy in isolation guided the localization of a tiny lymphoma restricted to the inferior division of the oculomotor nerve in the orbit.…”

Surgical management of oculomotor nerve palsy – a review of the literature

“…Additionally, a lesion affecting the topographically-distributed motor fibres in the cisternal portion of the nerve could cause a divisional paresis, despite being proximal to the bifurcation. 8 Superior divisional lesions typically present with an upper eyelid ptosis and limitation of elevation on the ipsilateral side, due to the paresis of the SR and LPS muscles. 8 Inferior divisional lesions, whilst being very rare (Ing et al reported only 1 in 54 patients with OMN palsy having such a lesion 9 ), classically present with large exotropia, hypertropia and intorsion of the affected eye.…”