Sphenoid sinus mucocoele presenting with isolated oculomotor nerve palsy. J Laryngol Otol. 1997 5;111(5):471–473. PMID: 9205613. 10. Lin CJ, Kao CH, Kang BH, Wang HW. Frontal sinus mucocele presenting as oculomotor nerve palsy. [e-ceo.org]

Presents a more streamlined format to the printed text to help you focus on the clinically actionable information you need everyday. [books.google.com]

We present a case of bilateral oculomotor nerve paralysis induced by alpha II-interferon in a patient with hairy-cell leukemia. After the drug was withdrawn, the neurological abnormalities disappeared. [ncbi.nlm.nih.gov]

• Nausea

  The oculomotor nucleus, located in the midbrain, can be affected if the blood supply to the midbrain is decreased. 6 Patients may also present with nausea, vertigo, and other cranial nerve or neurologic deficits. [aafp.org]

  There may be associated symptoms such as ptosis, eye pain (with or without eye movement), headache and nausea. Signs/examination Check for ptosis, which is often the first sign of weakness. [patient.info]

  · Vertigo and nausea: They are partly due to diplopia, and partly due to false orientation. · Secondary angle of deviation is more than the primary deviation. · Restriction of ocular movements in the direction of action of paralyzed muscle. · Compensatory [thamburaj.com]

• Fracture

  Occlusion of basilar artery within a fracture of clivus. J Neurosurg 66 1987; 929-931 5 Arivazhagan A, Garg N, Indira Devi B, Rose Dawn B, Pandey P. [thieme-connect.com]

  A fracture of the anterior petrous bone may affect the third cranial (oculomotor) nerve as well as the eighth (acoustic) nerve. This matches perfectly with the. . . [nejm.org]

  Finally the 3rd nerve enters the orbit as superior and inferior branches through the superior orbital fissure and may be damaged by orbital fractures. [eyes.gp-surgery.com]

  Muscles (particularly the inferior rectus) may be trapped during basal orbital fracture. [patient.info]

  A basal skull fractures may cause both unilateral and bilateral palsies. The intracavernous part runs forwards below the third and fourth nerves, as well as the first division of the fifth. [thamburaj.com]

• Diplopia

  Do not appreciate diplopia when overcorrect until 50Δ BI 8. 4. [slideshare.net]

  Prism spectacles may relieve diplopia for some patients. [aapos.org]

  Diplopia may be a complication after refractive surgery. Ocular lesions, including diplopia, can be amongst the presenting features of Creutzfeldt-Jakob disease (CJD), especially new variant CJD [ 4 ]. [patient.info]

  Symptoms and signs include diplopia, ptosis, and impaired adduction and upward and downward gaze. [msdmanuals.com]

• Strabismus

  Paralytic strabismus poses a significant diagnostic and therapeutic challenge. [1] The prevalence of paralytic strabismus is variable in different studies. [jovr.org]

  […] due to nerve palsy ( H49.0 - H49.2 ) Strabismus (congenital) (nonparalytic) H50.9 ICD-10-CM Diagnosis Code H50.9 Unspecified strabismus 2016 2017 2018 2019 Billable/Specific Code paralytic H49.9 ICD-10-CM Diagnosis Code H49.9 Unspecified paralytic strabismus [icd10data.com]

  Two common ones are Strabismus - a disorder in which the two eyes don't line up in the same direction. This results in "crossed eyes" or "walleye." [icdlist.com]

  J Pediatr Ophthalmol Strabismus. 1991;28:10–13. Salazar-León JA, Ramírez-Ortíz MA, Salas-Vargas M. The surgical correction of paralytic strabismus using fascia lata. J Pediatr Ophthalmol Strabismus. 1998;35:27–32. [healio.com]

  The patient with this type of paralysis will usually develop strabismus and double vision. Fourth Nerve Palsy Paralysis of this cranial nerve affects the superior oblique muscle. [clinicadeojosdetijuana.com]

• Lacrimation

  (Lacrimal Apparatus Diseases) Arcus Senilis Arcus, Corneal (Arcus Senilis) Asthenopia Astigmatism Astrocytoma, Malignant, Optic Nerve (Optic Nerve Glioma) Atrophies, Gyrate (Gyrate Atrophy) Atrophies, Hereditary Optic (Optic Atrophies, Hereditary) Atrophy [provisu.ch]

  lacrimal gland Motor (somatic) Muscles of facial expression Eyelid closing : orbicularis oculi muscle Jaw opening: posterior belly of the digastric muscle Hyoid elevation: stylohyoid muscle Efferent arm of the acoustic reflex ( stapedius muscle ) VIII [amboss.com]

  Here the nerve is placed below the trochlear nerve and the frontal and lacrimal branches of the ophthalmic nerve, while the nasociliary nerve is placed between its two rami: superior branch of oculomotor nerve inferior branch of oculomotor nerve As mentioned [ispub.com]

  The Autonomic Nervous System: disorders of pupillary function, accommodation and lacrimation. Volume 1. Edited by: Miller NR, Newman NJ. 2005, Lippincott Williams and Wilkins,, 739-804. [jmedicalcasereports.biomedcentral.com]

• Unilateral Ptosis

  With unilateral third cranial nerve palsy, the involved eye usually is deviated down and out (infraducted, abducted), and there is ptosis, which may be severe enough to cover the pupil. [ispub.com]

  A few key points once more: The oculomotor palsy is characterized by unilateral ptosis and an eye that is down and out. Pupil dilation suggests compression, possibly by berry aneurysm. [eyes.gp-surgery.com]

  Other patterns of weakness cannot occur with nuclear lesions, such as III nerve palsy with unilateral ptosis or unilateral mydriasis. [neuroophthalmology.ca]

  A patient with acute CN III palsy usually presents with a sudden onset of unilateral ptosis and ophthalmoplegia, which is frequently accompanied by significant eye or head pain––depending on the underlying cause. 1-4 Such patients often complain of double [reviewofoptometry.com]

• Blepharoptosis

  Equal size pupils without blepharoptosis (top) in the interval between attacks of left-sided blepharoptosis, and maximally enlarged pupil during an attack (bottom, arrow) (with written permission of the patient). [frontiersin.org]

  Keywords : Blepharoptosis ; Mucocele ; Oculomotor nerve INTRODUCTION A mucocele is a slowly progressing benign lesion caused by the retention of mucous secretions and expansion due to the continuous obstruction of the orifice of the sinus or a minor salivary [e-ceo.org]

  Generally, patients present with blepharoptosis, limitation in eye movements accompanied by strabismus and a dilated pupil reacting to light. [9] Most reports have stated ischemia as the most common cause of the oculomotor nerve paralysis. [4], [5] Although [jovr.org]

• Stroke

  Keywords Nerve Palsy Hemorrhagic Stroke Cranial Nerve Nucleus Oculomotor Function Thalamic Stroke Introduction Cases of stroke that result in isolated third nerve palsy without other significant non-ocular signs are rare. [jmedicalcasereports.biomedcentral.com]

  […] selectively affects somatic fibers over parasympathetic fibers, while traumatic stroke affects both types more equally. [en.wikipedia.org]

  Bilateral Fascicular Third Nerve Palsy in Posterior Circulation Stroke. Neuro-Ophthalmology, p. 1. CrossRef Google Scholar Fu, Qichang Guan, Sheng Liu, Chao Wang, Keyan and Cheng, Jingliang 2018. [cambridge.org]

  […] myeloma (in remission) Asthma Seasonal allergies Medications: Infection prophylaxis (acyclovir, butenafine, trimethoprim-sulfamethoxazole) Multiple myeloma remission maintenance (prednisone 5 mg twice a day) Family History: Mother: thyroid cancer Father: stroke [eyerounds.org]

  These include vascular conditions such as strokes or aneurysms, space-occupying lesions in the orbit or skull (neoplastic or vascular), migraine or any cause of raised intracranial pressure. [patient.info]

• Cranial Nerve Involvement

  Lower cranial nerve involvement, leading to respiratory, swallowing, and cardiac difficulties, was also present. Pathologic examination of the brainstem showed absent or hypoplastic third, seventh, tenth, and twelfth nerve nuclei. [ncbi.nlm.nih.gov]

• Areflexia

  Areflexia is often elicited, especially of the Achilles’ tendon. Areflexia often does not develop at the same time as the tonic pupil and may not be elicited on first presentation. [neuro-ophthalmology.stanford.edu]

If carcinomatous meningitis is diagnosed on cerebrospinal fluid workup, then a search for systemic metastatic disease, an occult primary carcinoma, lymphoma, or leukemia is warranted. [emedicine.medscape.com]

Nevertheless, basic workup must be done. [eyewiki.aao.org]

Antibody—negative Toxoplasma PCR—negative Varicella Zoster PCR—negative Urine Studies Histoplasma Antigen Assay—negative Imaging Studies MRI brain with contrast, MRA head with contrast CT chest/abdomen/pelvis with contrast Transesophageal Ultrasound The workup [eyerounds.org]

[…] changes in the biochemical environment arising from head trauma, have been suggested in these cases. 7 While relatively uncommon, cases of isolated ONP should be viewed by clinicians as suggestive of additional neurological injury and in need of further workup [dovepress.com]

Acute palsy in individuals less than 40 years of age suggests need for neuroimaging and a complete neurological workup. Common cause of isolated oculomotor nerve involvement is intracranial aneuryms. [djo.org.in]

Two (3.8%) subjects received only medical treatment. 26 (50%) patients received only surgical treatment and both medical and surgical treatments were done in 20 (38.4%) cases. [jovr.org]

Compressive lesions (eg, aneurysm or tumor) that are treated endovascularly or surgically may also improve or resolve following treatment. [emedicine.com]

Treatment of the cause Treatment of 3rd cranial nerve palsy depends on the cause. Emergency treatment is required if a life-threatening disorder is the cause. NOTE: This is the Consumer Version. [msdmanuals.com]

Helps you make optimal use of the newest drug therapies, including Anti-VEGF treatment for wet ARMD and bevacizumab treatment for complications of diabetes. [books.google.com]

Prognosis The prognosis of an oculomotor palsy depends on the etiology. Posttraumatic, postinfectious, postinflammatory, and ischemic oculomotor palsies may partially or completely recover spontaneously. [emedicine.com]

Prognosis : guarded. Pathogenesis Etiology Inflammatory diseases, eg distemper Canine distemper disease, granulomatous meningoencephalitis Granulomatous meningoencephalomyelitis. Space occupying lesions, eg neoplasia Brain: neoplasia. [vetstream.com]

Risk Factors and prognosis of isolated ischemic third, fourth, or sixth cranial nerve palsies in the Korean population. J Neuroophthalmol 2015;35:37–40. 13. Gross G, Schöfer H, Wassilew S, et al. [synapse.koreamed.org]

Prognosis is good. Many people get better over 3 to 6 months. However, some people have permanent eye muscle weakness. [medlineplus.gov]

17-35% of causes. [4], [5], [6] However, aneurysmal and a neoplastic causes were nearly equal (up to 19%), and a large percentage of patients in each series had an undetermined etiology. [13], [14] In the current study, trauma was the most common etiology [jovr.org]

Epidemiology Frequency United States Oculomotor nerve palsy is uncommon, and its frequency varies depending on the etiology. [emedicine.com]

Etiology Clinical features Extorsion of the eye : inability to depress and adduct the eyeball simultaneously (the pupil shoots upward during attempted adduction of the eyeball) Diplopia ( double vision ) Mild esotropia Trigeminal nerve lesion (V) Etiology [amboss.com]

The most common known etiology is a posterior communicating artery aneurysm. This is a medical emergency. [eyewiki.aao.org]

+/-aberrant regeneration (common) +/-cyclic oculomotor spasm significant risk of amblyopia Acquired Third Nerve Palsy uncommon usually unilateral etiology: trauma (more common in children) neoplasm (primary or metastatic tumor) aneurysm (more common in [www2.medicine.mcgill.ca]

This study was performed to determine epidemiologic and etiologic distribution and results of strabismus surgery in patients with third nerve palsy referred to our clinic as a tertiary center over a 10-year period. [jovr.org]

Epidemiology in glaucoma. In: Yanoff M, Duker JS, eds. Ophthalmology. 2nd ed. St Louis: Mosby Elsevier, 2009:1017-1019. 3. Fraser S, Wormald R. Epidemiology in glaucoma. In: Yanoff M, Duker JS, eds. Ophthalmology. 2nd ed. [cmej.org.za]

Epidemiology Frequency United States Oculomotor nerve palsy is uncommon, and its frequency varies depending on the etiology. [emedicine.com]

Epidemiology Adie’s tonic pupil occurs in a 3:1 female to male ratio with an average age of onset of 32 years.[1] General Pathology It is thought that either a bacterial or viral infection causes inflammation which damages neurons in the ciliary ganglion [neuro-ophthalmology.stanford.edu]

Diagnosis: Third Nerve Palsy with Contralateral Hemiplegia Secondary to Midbrain Fungal Abscess Epidemiology of a midbrain fungal abscess Immunocompromised Individuals Use of chronic immunomodulators Stem cell transplant Solid organ transplant Leukemia [eyerounds.org]

Pathophysiology Anatomy and function The oculomotor nerve serves two functions: Movement of the eye. Pupillary constriction. These functions are controlled by differing nuclear areas. [vetstream.com]

In some cases, the precise site of the lesion is clear, whereas in others, the location of the lesion is speculative. [1] Pathophysiology To understand the pathophysiology of the oculomotor nerve palsy it is essential to know its track. [eyewiki.aao.org]

Pathophysiology The anatomical relationship of the various portions of the oculomotor (third) cranial nerve accounts for many of the clinical features of third cranial nerve palsy as outlined below. [emedicine.com]

Pathophysiology Histologic examination of patients with Adie’s Syndrome has shown a reduction of ciliary ganglion cells.[1] The affected short ciliary neurons are postganglionic parasympathetic neurons which synapse within the ciliary ganglion and innervate [neuro-ophthalmology.stanford.edu]

The pathophysiology of nerve palsy in the orbit caused by mucoceles is not well-known. [e-ceo.org]

Echothiophate, by preventing acetylcholine hydrolysis, may have allowed this transmitter to accumulate and to produce miosis. [ncbi.nlm.nih.gov]

Non-surgical treatments: patching in visually immature children to prevent amblyopia occlusion or prisms to relieve diplopia in visually mature individual (especially during the observation period) botulinum toxin injection of the antagonist muscle(s) [www2.medicine.mcgill.ca]

This condition often causes vertical double vision as the weakened muscle prevents the eyes from moving in the same direction together. [clinicadeojosdetijuana.com]

[…] persistence of the esodeviation – high suspicion of amblyopia. • Alternate occlusion prevents secondary contracture of muscles and also amblyopia. [cmej.org.za]

To further clarify, classically a posterior communicating artery aneurysm will cause compression of the entire third nerve and so prevent ANY nerve signal conduction thus affecting the somatic system and also the autonomic. [en.wikipedia.org]