Third nerve palsy - Revision history

Danbot: Add evidence-based Disposition section

2026-03-22T10:03:17Z

Add evidence-based Disposition section

← Older revision		Revision as of 10:03, 22 March 2026
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	*If [[diplopia]]		*If [[diplopia]]
	**No driving or operating heavy machinery		**No driving or operating heavy machinery

			==Disposition==
			*Admit for:
			**Pupil-involving third nerve palsy (posterior communicating artery aneurysm until excluded by CTA/MRA)
			**New complete third nerve palsy with pain
			**Associated altered mental status or other neurologic deficits
			*Discharge with urgent neurology/ophthalmology follow-up (24-48 hours) for:
			**Isolated pupil-sparing third nerve palsy in patient with vascular risk factors (likely microvascular)
			**Known chronic third nerve palsy with stable exam

	==See Also==		==See Also==

Rossdonaldson1: /* Background */

2020-09-26T16:21:18Z

Background

← Older revision		Revision as of 16:21, 26 September 2020
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	==Background==		==Background==
	[[File:Gray785.png\|thumb\|Figure showing the mode of innervation of the recti lateralis from CNII.]]		[[File:Gray785.png\|thumb\|Figure showing the mode of innervation of the recti lateralis from CNII.]]
	[[File:Capture2.PNG\|thumbnail]]		[[File:Capture2.PNG\|thumbnail\|Right eye]]
	[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]		[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]
	*Third (oculomotor) nerve, innervates eyelid muscles and external ocular muscles (except lateral rectus and superior oblique) <ref>Capo, H., M.D., Warren, F., M.D., Kupersmith, M. , M.D. Evolution of Oculomotor Nerve Palsies. J Clin Neuroophthalmol. 1992 Mar;12(1):21-5. (12)1:21-25, 1992.</ref>		*Third (oculomotor) nerve, innervates eyelid muscles and external ocular muscles (except lateral rectus and superior oblique) <ref>Capo, H., M.D., Warren, F., M.D., Kupersmith, M. , M.D. Evolution of Oculomotor Nerve Palsies. J Clin Neuroophthalmol. 1992 Mar;12(1):21-5. (12)1:21-25, 1992.</ref>

Rossdonaldson1: /* Clinical Features */

2020-09-26T16:18:32Z

Clinical Features

← Older revision		Revision as of 16:18, 26 September 2020
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	==Clinical Features==		==Clinical Features==
			[[File:PMC4134542 OJO-7-103-g001.png\|thumb\|Complete (isolated) third nerve palsy showing (a) left-sided ptosis, (b) restricted adduction movement of left eyeball, and (c) normal abduction movement of left eyeball.]]
	*Eye deviates laterally and down		*Eye deviates laterally and down
	*Pupil exam:		*Pupil exam:

Rossdonaldson1: /* Background */

2020-09-26T16:12:36Z

Background

← Older revision		Revision as of 16:12, 26 September 2020
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	==Background==		==Background==
			[[File:Gray785.png\|thumb\|Figure showing the mode of innervation of the recti lateralis from CNII.]]
	[[File:Capture2.PNG\|thumbnail]]		[[File:Capture2.PNG\|thumbnail]]
	[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]		[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]

Rossdonaldson1: /* Background */

2020-09-26T16:12:16Z

Background

← Older revision		Revision as of 16:12, 26 September 2020
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	==Background==		==Background==
			[[File:Capture2.PNG\|thumbnail]]
			[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]
	*Third (oculomotor) nerve, innervates eyelid muscles and external ocular muscles (except lateral rectus and superior oblique) <ref>Capo, H., M.D., Warren, F., M.D., Kupersmith, M. , M.D. Evolution of Oculomotor Nerve Palsies. J Clin Neuroophthalmol. 1992 Mar;12(1):21-5. (12)1:21-25, 1992.</ref>		*Third (oculomotor) nerve, innervates eyelid muscles and external ocular muscles (except lateral rectus and superior oblique) <ref>Capo, H., M.D., Warren, F., M.D., Kupersmith, M. , M.D. Evolution of Oculomotor Nerve Palsies. J Clin Neuroophthalmol. 1992 Mar;12(1):21-5. (12)1:21-25, 1992.</ref>
	*Nerve also carries parasympathetic fibers on external surface allowing for pupillary constriction		*Nerve also carries parasympathetic fibers on external surface allowing for pupillary constriction

Rossdonaldson1: /* See Also */

2020-09-26T16:07:59Z

ClaireLewis: /* References */

2019-10-03T16:37:27Z

References

← Older revision		Revision as of 16:37, 3 October 2019
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	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]
	[[Category:Neurology]]		[[Category:Neurology]]
			[[category:Symptoms]]

ClaireLewis: /* Binocular Diplopia */

2019-09-28T18:32:01Z

Binocular Diplopia

← Older revision		Revision as of 18:32, 28 September 2019
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	===Binocular Diplopia===		===Binocular Diplopia===
	*Basilar Artery Thrombosis		*Basilar Artery Thrombosis
	*[[Posterior Communicating Artery (PCOM) Aneurysm]]		*[[Posterior Communicating Artery (PCOM) Aneurysm\|Posterior communicating artery (PCOM) aneurysm]]
	*Vertebral artery dissection		*[[vertebral and carotid artery dissection\|Vertebral artery dissection]]
	*[[Myasthenia Gravis]]<ref>Kusner LL, Puwanant A, Kaminski HJ: Ocular myasthenia: Diagnosis, treatment, and pathogenesis. Neurologist 2006; 12:231-239</ref>		*[[Myasthenia Gravis]]<ref>Kusner LL, Puwanant A, Kaminski HJ: Ocular myasthenia: Diagnosis, treatment, and pathogenesis. Neurologist 2006; 12:231-239</ref>
	*[[Lambert-Eaton Myasthenic Syndrome \|Lambert-Eaton Syndrome]]		*[[Lambert-Eaton Myasthenic Syndrome \|Lambert-Eaton Syndrome]]
	*[[Botulism]]		*[[Botulism]]
	*[[Cavernous sinus thrombosis]]		*[[Cavernous sinus thrombosis]]
	*[[Intracranial ~~Mass~~]], brainstem mass		*[[Intracranial mass]], brainstem mass
	*Miller Fischer variant [[Guillain-~~Barré~~]]<ref>Bushra JS: Miller Fisher syndrome: An uncommon acute neuropathy. J Emerg Med 2000; 18:427-430</ref>		*Miller Fischer variant [[Guillain-Barre]]<ref>Bushra JS: Miller Fisher syndrome: An uncommon acute neuropathy. J Emerg Med 2000; 18:427-430</ref>
	*[[Multiple Sclerosis (MS)\| MS]]		*[[Multiple Sclerosis (MS)\| MS]]
	*[[Hyperthyroidism \| Hyperthyroid]] Proptosis		*[[Hyperthyroidism \| Hyperthyroid]] Proptosis

ClaireLewis: /* Causes */

2019-09-28T18:23:54Z

Causes

← Older revision		Revision as of 18:23, 28 September 2019
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	*[[Myasthenia Gravis]]<ref>Appenzeller S, Veilleux, M. Clarke, A. Lupus. Third cranial nerve palsy or pseudo 3rd nerve palsy of myasthenia gravis? A challenging diagnosis in systemic lupus erythematosus. 2009 Lupus. Aug;18(9):836-40. </ref>		*[[Myasthenia Gravis]]<ref>Appenzeller S, Veilleux, M. Clarke, A. Lupus. Third cranial nerve palsy or pseudo 3rd nerve palsy of myasthenia gravis? A challenging diagnosis in systemic lupus erythematosus. 2009 Lupus. Aug;18(9):836-40. </ref>
	*[[Cavernous Sinus Thrombosis]]		*[[Cavernous Sinus Thrombosis]]
	**often associated with other cranial nerve ~~defecits~~		**often associated with other [[cranial nerve palsies\|cranial nerve deficits]]
	*[[Neurosyphilis]]		*[[Neurosyphilis]]
	*Autoimmune [[vasculitis]] ([[Systemic Lupus Erythematosus\|Lupus]])		*Autoimmune [[vasculitis]] ([[Systemic Lupus Erythematosus\|Lupus]])

ClaireLewis: /* Background */

2019-09-28T18:23:28Z

Background

← Older revision		Revision as of 18:23, 28 September 2019
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	**[[Diabetes]]		**[[Diabetes]]
	*[[Trauma]]		*[[Trauma]]
	**Temporal lobe [[herniation ~~syndromes~~\|herniation]] through tentorium		**Temporal lobe [[herniation Syndromes\|herniation]] through tentorium
	*[[Myasthenia Gravis]]<ref>Appenzeller S, Veilleux, M. Clarke, A. Lupus. Third cranial nerve palsy or pseudo 3rd nerve palsy of myasthenia gravis? A challenging diagnosis in systemic lupus erythematosus. 2009 Lupus. Aug;18(9):836-40. </ref>		*[[Myasthenia Gravis]]<ref>Appenzeller S, Veilleux, M. Clarke, A. Lupus. Third cranial nerve palsy or pseudo 3rd nerve palsy of myasthenia gravis? A challenging diagnosis in systemic lupus erythematosus. 2009 Lupus. Aug;18(9):836-40. </ref>
	*[[Cavernous Sinus Thrombosis]]		*[[Cavernous Sinus Thrombosis]]

← Older revision		Revision as of 16:07, 26 September 2020
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	*[[Cranial nerves]]		*[[Cranial nerves]]
	*[[Diplopia]]		*[[Diplopia]]
			*[[Ocular palsy]]

	==References==		==References==