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Oculomotor Nerve Palsy, Emergency Medicine

Adam Z. Barkin Reviewed 06/2017
 


Basics

Description

  • Typical presentation of a 3rd cranial nerve (CN) palsy:

    • Eyelid drooping

    • Blurred or double vision

    • Light sensitivity

    • May also have other neurologic signs/symptoms:

      • Hemiplegia

      • Ataxia

      • Tremor

  • CN ...

Diagnosis

Signs and Symptoms

A careful history and physical exam are vital to narrow down the differential diagnosis 

History

History is of utmost importance in determining cause: 
  • Headache

  • Pupillary dilat...

Treatment

Pre-Hospital

Without associated trauma, no specific pre-hospital care issues exist 

Initial Stabilization/Therapy

  • Initial stabilization of trauma patient should concentrate on underlying injuri...

Follow-Up

Disposition

Admission Criteria

  • Complete oculomotor nerve palsy of any cause requires admission and emergency neurosurgical evaluation

  • Incomplete oculomotor nerve palsy with abnormal CT or MRI, ...

Pearls and Pitfalls

  • Complete lesions must be assessed rapidly

  • Patients <50 yr old with any extent of CN III palsy should be evaluated for compressive lesions

  • If the pupil is involved, compressive les...

Additional Reading

  • Bruce  BB, Biousse  V, Newman  NJ. Third nerve palsies. Semin Neurol.  2007;27:257–268.

  • Chen  CC, Pai  YM, Wang  RF, et al. Isolated oculomotor nerve palsy from minor head traum...

Codes

ICD9

  • 378.51 Third or oculomotor nerve palsy, partial

  • 378.52 Third or oculomotor nerve palsy, total

ICD10

  • H49.00 Third [oculomotor] nerve palsy, unspecified eye

  • H49.01 Third [oculomotor] nerve palsy, ...

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