Figure 64: The Course of the 3rd (III) Nerve

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Identifier gold_textbook_figures_064
Title Figure 64: The Course of the 3rd (III) Nerve
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Description The 3rd nucleus lies at the ventral border of the periaqueductal gray matter, at the level of the superior colliculus. In between the two nuclei is the midline central caudal nucleus (CCN), which innervates bilateral levator palpebrae muscles (explaining how a unilateral nuclear 3rd can cause bilateral ptosis). The 3rd nerve fascicle (fibers responsible the pupillary sphincter [P], inferior rectus [IR], levator palpebrae [LP], medial rectus [MR], superior rectus [SR], and inferior oblique [IO] are located medial to lateral) travels anteriorly through the tegmentum, the red nucleus, the substantia nigra, and finally exits the midbrain medially from the cerebral peduncles. The peripheral portion of the 3rd nerve courses between the superior cerebellar and posterior cerebral arteries and then passes the posterior communicating artery (PCOM aneurysm causes compression here) and the temporal lobe uncus (uncal herniation can cause compression here), then above the petroclinoid (Gruber's) ligament (while the 6th nerve travels under) and into the cavernous sinus where it is located laterally. The separation into superior (SR, LP) and inferior (P and ciliary body, MR, IR, IO) divisions occurs in the anterior sinus, and these branches then travel through the superior orbital fissure to enter the orbit, passing through the annulus of Zinn before innervating their respective muscles. Castro O, Johnson LN, Mamourian AC. Isolated inferior oblique paresis from brain-stem infarction. Perspective on oculomotor fascicular organization in the ventral midbrain tegmentum. Arch Neurol. 1990;47(2):235-7.
Date 2022
References Gold D. (2022). Neuro-ophthalmology and neuro-otology : a case-based guide for clinicians and scientists. Springer International Publishing AG. Retrieved September 16 2022 from https://online.statref.com/p/1057?grpAlias=.
Language eng
Format image/jpeg
Type Image
Relation is Part of Neuro-Ophthalmology and Neuro-Otology: A Case-Based Guide for Clinicians and Scientists
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6b1vht2
File Name gold_textbook_figures_064.png
Setname ehsl_novel_gold
ID 2050034
Reference URL https://collections.lib.utah.edu/ark:/87278/s6b1vht2
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