7.1 Cranial Nerve III (Oculomotor) Palsy
7.2 Cranial Nerve IV (Trochlear) Palsy
7.3 Cranial Nerve VI (Abducens) Palsy
7.4 Cranial Nerve VII (Facial) Palsy
7.5 Optic Nerve Function
7.6 Visual Fields to Confrontation
7.7 Pupils
7.8 Horner’s Syndrome
7.9 Nystagmus
7.10 Neuro-Ophthalmic Differential Diagnoses and Aetiologies
Cranial nerve VI palsies are extremely common in examinations. Although relatively simple to diagnose, it is important that the examiner look carefully for signs of associated cranial nerve palsies, Horner’s syndrome and papilloedema.
Millard-Gubler syndrome
Ipsilateral CNVI, CNVII+
Contralateral hemiplegia (corticospinal tract)
Foville syndrome
Ipsilateral horizontal gaze palsy (PPRF), CNVII+
Contralateral hemiplegia (corticospinal tract), INO
Summary
Microvascular
HT, Cholesterol, DM, Smoking
Macrovascular
Internal carotid artery aneurysm (cavernous sinus). Subarachnoid haemorrhage, carotico-cavernous fistula, cavernous sinus thrombosis, pituitary apoplexy
Treat the underlying cause (e.g. diabetes, hypertension).
Indications for treatment:
Aims:
Nishida Y, Inatomi A, Aoki Y, et al. A muscle transposition procedure for abducens palsy, in which the halves of the vertical rectus muscle bellies are sutured onto the sclera. Jpn J Ophthalmol. 2003;47(3):281‐286. doi:10.1016 / s0021-5155(03)00021-2
Risks
An isolated CNVI palsy is never nuclear due to the close relationship of the CNVII fasciculus (wraps around it).
A lesion in the CNVI nucleus causes: Ipsilateral horizontal gaze palsy (PPRF) ± Ipsilateral LMN CN VII palsy.
Millard-Gubler syndrome
Ipsilateral CNVI, CNVII +
Contralateral hemiplegia (corticospinal tract).
Foville syndrome
Ipsilateral horizontal gaze palsy (PPRF), CNVII +
Contralateral hemiplegia (corticospinal tract), INO.
Ipsilateral V (1st sign), VI, VII, VIII (1st symptom)
Travels between pons / pyramids either side of the start of the basilar artery
Through Cavernous sinus
Enters the Superior Orbital Fissure through the Common tendinous ring → LR
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