Central (Nuclear) 3rd Nerve Palsies

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Identifier central_3rds-Gold
Title Central (Nuclear) 3rd Nerve Palsies
Subject Range of eye movements/motility abnormal; Third nuclear; Upgaze palsy; Downgaze palsy; Mesencephalon; Jerk nystagmus; Rotary nystagmus
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, The Johns Hopkins School of Medicine
Description Shown here are two patients with left sided midbrain pathology (hemorrhage and ischemia) which caused damage to the 3rd nucleus. Both of the patients have ipsilateral mydriasis, adduction, supra- and infraduction paresis. Ipsilateral>contralateral ptosis is also present, and localizes to the central caudal nucleus. Additionally, both patients have supraduction paresis in the contralateral right eye as well. This is because the fascicles destined for the right superior rectus (SR) muscle originates in the opposite left SR subnucleus - i.e., along with the 4th nerve, the SR fascicles are the only other cranial nerve to decussate. Interesting, in both of these patients there's also infraduction paresis in the contralesional (right) eye, and because there's no clear right 3rd nerve palsy, this is probably suggestive of additional interstitial nucleus of Cajal and/or rostral interstitial MLF damage (and INC or riMLF damage could also be contributing to supraduction deficits as well). In the second patient, there was also mainly torsional nystagmus (beating towards the right ear, not seen in the left eye likely due to significant ophthalmoparesis in this eye) seen in the right eye. A unilateral riMLF lesion can cause contralesional torsional nystagmus while a unilateral INC lesion can cause ipsilesional torsional nystagmus - in her case, given the left sided midbrain stroke, the assumption was that her torsional nystagmus (towards the right ear) was related to additional damage involving the left riMLF.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2016
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
File Name central_3rds-Gold.mp4
Language eng
ARK ark:/87278/s6mw65f7
Setname ehsl_novel_gold
Date Created 2017-02-28
Date Modified 2017-04-18
ID 1209828
Reference URL https://collections.lib.utah.edu/ark:/87278/s6mw65f7
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