Summary
Of 61 patients with isolated third nerve palsy, 23 (38%) had the characteristic clinical features of an ischaemic oculomotor nerve palsy. The essential sign of this usually painful disorder of acute onset was a marked discrepancy between complete or severe paresis of the extraocular muscles innervated by the third nerve, and sparing of the pupillary sphincter. All patients had completely recovered within 3 months. Fourteen had a history or on follow-up had other cranial mononeuropathies. Except for two patients, all were above the age of 60 years. Of the 23 cases, 11 had diabetes mellitus and 8 an abnormal glucose tolerance test, while in 4 the latter was normal. Almost all had hypertension and were overweight, and half were smokers. In 18 patients, four or five vascular risk factors were present.
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References
Asbury AK, Aldrege H, Hershberg R, Fisher CM (1970) Oculomotor palsy in diabetes mellitus: a clinico-pathological study. Brain 93:555–666
Bahill AT, Clark MR, Stark L (1975) Dynamic overshoot in saccadic eye movements is caused by neurological control signal reversals. Exp Neurol 48:107–122
Boghen D (1980) The pupil in cavernous sinus aneurysm. Ann Neurol 8:202–203
Bühler FR, Lèche AS, Schüler G, Gutzwiller F, Baumann F, Schweizer W (1976) Das Hypertonieproblem in der Schweiz. Schweiz Med Wochenschr 106:99–107
Dreyfus PM, Hakim S, Adams RD (1957) Diabetic ophthalmoplegia: report of case, with postmortem study and comments on vascular supply of human oculomotor nerve. AMA Arch Neurol Psychiatry 77:337–349
Ellenberg M (1963) Diabetic complications without manifest diabetes. JAMA 183:926–930
European Diabetes Epidemiology Study Group (1970) Diabetologia 6:646–647
Glaser JS (1978) Neuro-ophthalmology. Harper and Row, Hagerstown, p 258
Goldstein JE, Cogan DG (1960) Diabetic ophthalmoplegia with special reference to the pupil. Arch Ophthalmol 64:592–600
Green WR, Hackett ER, Schlezinger NS (1964) Neuro-ophthalmologic evaluation of oculomotor nerve paralysis. Arch Ophthalmol 72:154–167
Gutzwiller F (1981) Epidemiologie des Blutdrucks in vier Schweizer Städten. Schweiz Med Wochenschr [Suppl] 12:40–46
Hypertension Detection and Follow-up Program Cooperative Group (1979) Reduction in mortality of persons with high blood pressure including mild hypertension. JAMA 242:2562–2571
Kasoff I, Kelly DL Jr (1975) Pupillary sparing in oculomotor palsy from internal carotid aneurysm. J Neurosurg 42:713–717
Kerr FWL, Hollowell OW (1964) Location of pupillomotor and accommodation fibres in the oculomotor nerve: experimental observations on paralytic mydriasis. J Neurol Neurosurg Psychiatry 27:473–481
Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL (1972) Indices of relative weight and obesity. J Chron Dis 25:329–343
Khosla T, Lowe CR (1967) Indices of obesity derived from body weight and height. Br J Prev Soc Med 21:122–128
Kissel JT, Burde RM, Klingele TG, Zeiger HE (1983) Pupil-sparing oculomotor palsies with internal carotid-posterior communicating artery aneurysms. Ann Neurol 13:149–154
Lincoff HA, Cogan DG (1957) Unilateral headache and oculomotor paralysis not caused by aneurysm. Arch Ophthalmol 57:181–189
Markwalder TM, Meienberg O (1983) Acute painful cavernous sinus syndrome in unruptured intracavernous aneurysms of the internal carotid artery: possible pathogenetic mechanisms. J Clin Neuroophthalmol 3:31–35
Raff MC, Asbury AK (1968) Ischemic mononeuropathy and mononeuropathy multiplex in diabetes mellitus. N Engl J Med 279:17–22
Rost G, Hinigmann G, Schliack V (1967) Der orale 50 g-Glukosetoleranztest zur Labordiagnose des Diabetes mellitus. Bewertung und altersabhängiger Verlauf. Z Inn Med 22:709–714
Rucker CW (1958) Paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol 46:787–794
Rucker CW (1966) The causes of paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol 61:1293–1298
Rush JA, Younge BR (1981) Paralysis of cranial nerves III, IV, and VI. Arch Ophthalmol 99:76–79
Stähelin HB (1976) Epidemiologie der Adipositas. Ther Umsch 33:717–722
Stark L, Vossius G, Young LR (1962) Predictive control of eye tracking movements. Institute of Radio Engeneering Transactions on Human Factors in Electronics, HFE-3, pp 52–57
Stephan E (1979) Kombination Schirmbild-Blutdruckmessung. Schweiz Med Wochenschr 109:234–243
Trobe JD, Glaser JS, Post JD (1978) Meningiomas and aneurysms of the cavernous sinus. Arch Ophthalmol 96:457–467
Veterans Administration Cooperative Study Group on Antihypertensive Agents (1970) Effects of treatment on morbidity in hypertension. JAMA 213:1143–1152
Walsh FB, Hoyt WF (1969) Clinical neuro-ophthalmology. Williams and Wilkins, Baltimore, pp 254–256, 397–398, 1109–1111
Weber RB, Daroff RB, Mackey EA (1970) Pathology of oculomotor nerve palsy in diabetics. Neurology (Minneap) 20:835–838
Weinstein EA, Dolger H (1948) External ocular muscle palsies occurring in diabetes mellitus. Arch Neurol Psychiatry 60:597–603
Weisshaar D (1975) Enzymatische Cholesterinbestimmung: Norm- (Referenz-) Bereiche. Med Welt 26:940–944
WHO (1978) Arterial hypertension. Techn Rep Ser 628:57
Zorilla E, Kozak G (1967) Ophthalmoplegia in diabetes mellitus. Ann Intern Med 67:968–976
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Teuscher, A.U., Meienberg, O. Ischaemic oculomotor nerve palsy. J Neurol 232, 144–149 (1985). https://doi.org/10.1007/BF00313889
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DOI: https://doi.org/10.1007/BF00313889