Trauma to Cranial Nerves II, IV, VI

The following will review the subject of traumatic dysfunction of the third, fourth, and sixth cranial nerves. The effects of direct trauma will be compared and contrasted with secondary, often compressive effects that supervene at an interval from the traumatic moment. Emphasis will be placed on radiographic features that characterize the various traumatic settings and locations. Mechanisms of tissue injury will be discussed when possible, but these remain speculative in many instances. The role of medical therapy such as high dose methylprednisolone pulse, acute surgical management, and of late palliative treatment such as ocular muscle surgery will also be discussed.