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Cranial Nerve Palsies

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Topic updated on 06/06/17 12:12pm

Overview of Cranial Nerves

3rd Cranial Nerve Palsies (Occulomotor)
Vasculopathic Third Nerve Palsy
Mr. Robberts, a 65 year women with a history of diabetes and hypertension presents in the emergency room with the right eye deviated outward and obvious ptosis. The pupils are normal. She complains of a slight headache

Third nerve deficit is outward rotation from medial rectus weekness and ptosis form levator palpebrae weekness. Pupil response and size is normal. Normal pupil size is important in distinguishing from a compressive third nerve palsy.

Because it non compressive, treated as nonemergent.
Compressive Third Nerve Palsy

Mr. Robberts, a 65 year women with a history of diabetes and hypertension presents in the emergency room with the right eye deviated outward and obvious ptosis. The pupil is dilated and unreactive. She complains of a slight headache.

Third nerve deficit is outward rotation from medial rectus weakness and ptosis form levator palpebrae weakness. Pupil is dilated and unreactive because of compression on the dorsal medial portion of the third nerve. Pupil response is important in distinguishing from a vasculopathic third nerve palsy.

Because it is compressive, treat as emergent.  
4th Cranial Nerve Palsies
 

 
Superior Oblique Palsy
Mr. Jones, was brought to the ER after a peds vs auto. His right eye is deviated outward and upward.

Caused from CN IV damage and is usually caused from trauma.

 
5th Cranial Nerve Palsies
 
 
 
6th Cranial Nerve (Abducens)
Lateral Rectus Palsy
A five year old child with a posterior fossa tumor complains of diplopia. On exam the child is noted to have stabismus..

Commonly associated with brain tumors in the pediatric population or cavernous sinus thrombosis. Present with diplopia (double vision) because they supress the image of the affected eye. It is a sign of increased intracranial pressure. Eye exam reveals strabismus from abducens involvement.

 


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(M2.NE.79) A 75-year-old man with a history of diabetes and hypertension presents to his ophthalmologist with blurry vision. He notes that his vision is clearest when looking down and to his right. His blood pressure is 155/98 mmHg, heart rate is 89 beats per minute, respiratory rate is 12 breaths per minute, and he is afebrile. On exam, his right eye is fixed in a "down and out" position, while his left eye maintains full range of motion. Which of the following additional findings would be an indication for urgent neurosurgical evaluation? Topic Review Topic

1. Dilated, nonreactive right pupil
2. Bilateral mydriasis
3. Isolated, right-sided ptosis
4. Isolated, left-sided ptosis
5. Bilateral ptosis

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