Occulomotor nerve

Clinical aspects

Frontal lobe

Temporal lobe

Sphenoid sinus

Optic chiasma

3

4

6 5-Opthalmic5-Maxillary

Ptosis

Deviation

Movement Restriction

Pupil

Accomodation Crossed Diplopia

Midbrain infarct

Asso with contralateral

Ptosiselevator palsy

Weber’s Syndrome-corticospinal(pyramidal) tract-contralateralhemiparesis.

Benedict’s Syndrome-Red nucleus-contralateral hemitremor

Nothnagel’s Syndrome -

-involves the superior cerebellar peduncle-cerebellar ataxia

Claude’s Syndrome -Nothnagel’s + Benedict’ssyndrome.

first indication ofaltered consciousness

Microvaslular abnormality like DM / HTN

-Transient 3 rd nerve palsy-Pupilary sparing

Berry anurysm at posterior communicating artery

-Headache-Neck stifness-Vomiting-Pupilary dilatation

Subarachnoid lesion

-Basal meningeal infection-Inflamation-Neoplastic infilteration

With multiple cranial nerve palsy

Frontal lobe

Temporal lobe

Sphenoid sinus

Optic chiasma

3

4

6 5-Opthalmic5-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,

Fracture of orbital wall would also lead 3rd

nerve palsy

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

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

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 rectimuscles 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

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