Cavernous sinus mass causing right 3rd and 4th nerve palsies
Third (Oculomotor) Nerve Palsy; Third subnuclear; Fourth (Trochlear) Nerve Palsy
Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, The Johns Hopkins School of Medicine
25-yo-man who complained of diplopia and was initially found to have right 4th and 6th nerve palsies in the setting of a right cavernous sinus mass (subsequently diagnosed as Ewing's sarcoma). When seen in follow-up (this video), there was a new right 3rd nerve palsy, still with a right 4th nerve palsy, and improved 6th nerve palsy. Video shows right 3rd and 4th nerve palsies (very mild 6th nerve palsy too) in the setting of a right cavernous sinus syndrome. In downgaze OD, there is no clear incyclotorsion of the eye, suggesting that the right 4th nerve is involved.
Spencer S. Eccles Health Sciences Library, University of Utah