Patterns of Extraocular Muscle Weakness in Vasculopathic Pupil-Sparing, Incomplete Third Nerve Palsy

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Title Journal of Neuro-Ophthalmology, December 2001, Volume 21, Issue 4
Publisher Lippincott, Williams & Wilkins
Date 2001-12
Type Text
Language eng
Rights Management © North American Neuro-Ophthalmology Society
Publication Type Journal Article
ARK ark:/87278/s6md254v
Setname ehsl_novel_jno
Date Created 2008-10-25
Date Modified 2020-03-03
ID 225101
Reference URL https://collections.lib.utah.edu/ark:/87278/s6md254v

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Title Patterns of Extraocular Muscle Weakness in Vasculopathic Pupil-Sparing, Incomplete Third Nerve Palsy
Creator Sanders, S; Kawasaki, A; Purvin, VA
Affiliation Associated Vitreo-Retinal and Uveitis Consultants Indianapolis, Indiana, USA.
Subject Adult; Aged; Aged, 80 and over; Female; Humans; Intracranial Aneurysm; Iris/innervation; Male; Middle Aged; Muscle Weakness/etiology; Oculomotor Muscles/innervation/pathology; Oculomotor Nerve Diseases/complications; Pupil/physiology; Retrospective Studies
Abstract OBJECTIVE: To determine the pattern of extraocular muscle (EOM) paresis in incomplete vasculopathic third nerve palsies (3NP) that have normal pupillary function. METHODS: A retrospective study in a private practice and academic neuro-ophthalmic practice. Patients diagnosed with vasculopathic 3NP within 4 weeks of symptom onset were identified. The chart of each patient was reviewed to determine pupillary function and the pattern and degree of EOM and levator palpebrae paresis at the time of presentation. RESULTS: Of 55 patients with vasculopathic 3NP, 42 (76%) had normal pupillary function. Of these 42, 23 (55%) demonstrated an incomplete EOM palsy, defined as partially reduced ductions affecting all third nerve-innervated EOMs and levator (diffuse pattern) or partially reduced ductions that involved only some third nerve-innervated EOMs and levator (focal pattern). Twenty (87%) of these 23 patients showed a diffuse pattern of paresis; only three (13%) showed a focal pattern of paresis, one that affected only the superior rectus and levator muscles (superior division weakness). CONCLUSIONS: Based on our series, most patients with EOM/levator involvement in pupil-sparing, incomplete 3NP of vasculopathic origin have a diffuse pattern of paresis. In contrast, our review of the literature suggests that pupil-sparing 3NP of aneurysmal origin usually have a focal pattern of paresis. We propose that distinguishing these two patterns of EOM paresis may be helpful in differentiating between vasculopathic and aneurysmal 3NP. Future studies will be needed to confirm the clinical utility of this hypothesis.
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Setname ehsl_novel_jno
Date Created 2008-10-25
Date Modified 2021-05-06
ID 225083
Reference URL https://collections.lib.utah.edu/ark:/87278/s6md254v/225083