Unilateral 3rd, 4th, and 6th Nerve Palsies Due to Cavernous Sinus Meningioma

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman presenting with a partial 3rd nerve palsy (mild pupil involvement), partial 6th nerve palsy, and no clear incyclotorsion with downgaze, suggestive of additional 4th nerve palsy, all on the left. With compressive lesions involving the 3rd nerve, often aberrant regeneration develops - in this case, injury to the left 3rd nerve miswiring so that some of the fibers destined for the left medial rectus instead went to the left levator palpebrae. When adducting the left eye, the eyelid elevated slightly. There was no evidence of aberrant regeneration causing any pupillary or motility findings. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This is a 50-yearold woman presenting with a partial 3rd nerve palsy (mild pupil involvement), partial 6th nerve palsy, and no clear incycloduction in downgaze, suggestive of additional 4th nerve palsy, all on the left. With compressive lesions involving the 3rd nerve, often aberrant regeneration develops - in this case, injury to the left 3rd nerve caused miswiring so that some of the fibers destined for the left medial rectus instead went to the left levator palpebrae. When adducting the left eye, the eyelid elevated slightly. There was no evidence of aberrant regeneration involving the pupil or ocular motility. https://collections.lib.utah.edu/ark:/87278/ s6wx16kc