Traumatic 3rd nerve palsy with aberrant regeneration
Third Nerve Palsy, , Third Subnuclear Palsy, Aberrant Regeneration
Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, The Johns Hopkins School of Medicine
This is a 20-yo-woman who experienced severe head trauma and diplopia upon awakening from a coma several weeks after the injury. She had a partial left 3rd nerve palsy (adduction spared), and when she looked to the right and down, her mildly ptotic lid elevated. Aberrant regeneration of CN 3 occurs mainly with trauma or with compressive lesions (eg, PCOM aneurysm, meningioma). The elevation in right gaze is explained by fibers intended to go to the left MR get misrouted to the left levator, while the elevation in down gaze is explained by fibers intended to go to the left IR get misrouted to the left levator causing levator activation and lid elevation.
Spencer S. Eccles Health Sciences Library, University of Utah