3rd cranial nerve
DESCRIPTION
3rd cranial nerveTRANSCRIPT
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