Third Nerve Palsies

Abstract

The diagnosis and management of third nerve dysfunction varies according to the age of the patient, characteristics of the third nerve palsy, and presence of associated symptoms and signs. Indeed, third nerve palsies may be partial or complete, congenital or acquired, isolated or accompanied by signs of more extensive neurological involvement. They can result from lesions located anywhere from the oculomotor nucleus to the termination of the third nerve in the extra-ocular muscles within the orbit. Recent advances in noninvasive neuroimaging facilitate early diagnosis; however, management of a patient presenting with an isolated third nerve palsy remains a challenge.

Pupil-Sparing Oculomotor Nerve Paresis as an Early Symptom of Unruptured Internal Carotid-Posterior Communicating Artery Aneurysms -Three Case Reports-

“…Pupillary dysfunction is important for differentiating between aneurysmal and diabetic oculomotor nerve paresis, in which pupillary function is usually normal. 2,5) However, a case of pupilsparing oculomotor nerve paresis caused by an IC-PC aneurysm has been reported. 4) Seven patients initially had normal pupils among 51 patients with IC-PC aneurysms manifesting as oculomotor nerve involvement, suggesting that the incidence of pupil sparing may be more common than previously appreciated in patients with IC-PC aneurysms and oculomotor nerve involvement.…”

Evaluation of Third Nerve Palsy in the Emergency Department

“…A CN III dysfunction can present with diplopia, ptosis, eye pain, headache, pupillary dilatation, monocular blurry vision, or any combination thereof (3). Unfortunately, the differential diagnosis for these complaints is broad and includes myasthenia gravis, botulism, orbital infections, orbital trauma, lens pathology, retinal pathology, migraine, and dysfunction of cranial nerves III, IV, and VI.…”

Complete Isolated Third Nerve Paresis Assosicated With Fusiform Dilatation of Middle Cerebral Artery

“…If meningeal signs are present, spinal fluid evaluation is warranted. A fully dilated and non-reactive pupil occurs in up to 71% of patients with aneurysmal compression and TNP (1,(4)(5)(6).…”

“…Basilar portion which extends from brain stem to cavernous sinus is the most important part and the most commonly seen anerusyms are posterior communicating artery related (1). New and recent advances in neuroimaging makes diagnosis easy; however, management of a patient presenting with an isolated third nerve palsy remains a challenge.…”