Oculomotor Palsey

Question 1

What is it

Answer 1

Dysfunction of the oculomotor nerve (cranial nerve III) leading to impaired eye movement, ptosis, and pupil abnormalities.

Question 2

Clinical Features

Answer 2

Ptosis (drooping eyelid) 😴
Eye deviation “down and out” (unopposed CN IV & VI) 👀⬇️➡️
Diplopia (double vision) 👓
Pupil involvement (if compressive lesion):
Dilated pupil (mydriasis)
Poor light reflex

Question 3

Epidemiology

Answer 3

Uncommon but serious 🚨
Occurs in vascular diseases, trauma, and brain tumors
Can be congenital or acquired

Question 4

Age Groups Affected

Answer 4

Young adults & middle-aged → Trauma, infection, aneurysms
Elderly (>50 years) → Microvascular causes (diabetes, hypertension)

Question 5

Risk Factors

Answer 5

✅ Modifiable:
• Diabetes mellitus 🍬
• Hypertension
• Smoking 🚬
• Atherosclerosis
• Head trauma
🚫 Non-Modifiable:
• Aneurysms (Posterior Communicating Artery – PComm) 🧠
• Brain tumors (compressive lesions)
• Congenital CN III palsy

Question 6

Clinical Presentation

Answer 6

🔹 Pupil-Involving CN III Palsy (Emergency 🚨 – Suggests Compression, e.g., Aneurysm or Tumor)

Dilated pupil (blown pupil) that doesn’t react to light
Severe headache (if due to aneurysm)
Ptosis & eye deviation (down and out position)
🔹 Pupil-Sparing CN III Palsy (More Benign – Suggests Microvascular Disease, e.g., Diabetes)

Ptosis & eye deviation
Pupil remains normal
Common in older patients with vascular risk factors

Question 7

Prognosis

Answer 7

🔹 Depends on the cause:

Microvascular (diabetes, hypertension): Often resolves in weeks/months

Aneurysm-related: High mortality if untreated! Requires urgent intervention

Trauma/tumor-related: May need surgery, recovery depends on severity
🔹 Prevention: Control diabetes, hypertension, smoking, and seek urgent care for sudden pupil involvement 🚨

Question 8

Test

Answer 8

H - Test

Light pupillary test