Diplopia Impaired Ocular Movement

CAUSES OF III NERVE LESION Midbrain

When bilateral

When III nerve lesion is associated with tremor or contralateral hemiparesis (weber's syndrome)

oculomotor nucleus red nucleus cerebral peduncles

Infarction, demyelination, intrinsic tumour, e.g glioma, basilar aneurysm compression

Orbital fissure/orbit

Look for proptosis and associated involvement of the IV, VI and first division of the V nerves

- Orbital tumour, granuloma,

- Periosteitis cerebral peduncles

Basilar artery

Basilar artery

Interpeduncular cistern when iii nerve lesion is associated with:

— Transtentorial herniation deterioration of conscious level retro-orbital pain ± sub -arachnoid haemorrhage meningism + other cranial nerve palsies pupil reaction spared sudden onset

Aneurysm compression (posterior communicating or basilar aneurysm)

Basal meningitis

- TB, syphilitic, bacterial, fungal

- carcinomatous

' Nerve trunk infarction

- hypertension,

- diabetes,

- polyarteritis nodosa,

Cavernous sinus

Look for associated involvement of IV, VI and 1st division of v nerve

- Tumour e.g. pituitary adenoma, meningioma, metastasis, nasopharyngeal carcinoma

- Intracavernous aneurysm

- Cavernous sinus thrombosis

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