Case of the week 115 (
May 2013 )
Third Nerve Palsy
64 years old patient has had a sudden onset
of dropped eyelid. He is diabetic and
hypertensive. He has bilateral background
diabetic retinopathy. CT brain and orbit shows
no significant data.
See video of this patient
Oculomotor nerve paralysis,
whether complete or incomplete, may have several
outcomes. First, complete recovery may occur,
sometimes in as little as a week or two. This
suggests recovery from neurapraxia, without axonal
loss. With presumed nerve infarcts associated with
diabetes, hypertension, or ophthalmoplegic migraine,
recovery does not begin for a month or more but is
usually complete within 3 months . This suggests a
lesion of axons, with preservation of nerve
connective tissue. With aneurysmal compression or
trauma, it can take up to 2 or 3 years to recover
completely, suggesting more severe anatomic
disruption of the nerve. If ptosis following trauma
is going to recover completely, it usually does so
within 6 months but occasionally takes as long as 2
years
In some cases of oculomotor nerve palsy, the
paralysis persists completely unchanged. These
nerves have usually been transected by trauma or
chronic compression or have been infiltrated by
tumor. Sometimes recovery is only partial. This
occurs especially after damage to the fascicular
portion of the nerve. Partial recovery may be
characterized by oculomotor nerve synkinesis,
so-called aberrant regeneration. Usually this
synkinesis becomes apparent within 9 weeks after
injury, but it has taken 3 to 6 months
This 65 years old diabetic patient has complete third
nerve palsy 5 days ago , most probably of
vascular origin , no history of trauma ,
bilateral normal optic nerve head. I usually ask for brain MRI
in acquired cranial nerve palsy to rule out
compressive lesions .
See Recovery process which lasts for about 1
year
4 months later
See video of this patient
4 months later
1 year later
الموقع المصري للحول
وامراض الجهاز الحركي للعين
The Egyptian Site of
Strabismus & Oculomotor Disorders
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