Oculomotor, Trochlear nerve, outreach nerve damage

Overview eye movement, pulleys and outreach denervated muscle and outside the eyes and eye movement, known collectively as eye movement neurons, Because of its close relationship between anatomy, and often simultaneously involved, it also described. Cause pathogenesis common cause with eye movement, pulleys and outreach nerve inflammation itself derived from paralysis Acute Infectious Polyneuritis, secondary in the head and face acute and chronic inflammation caused cavernous sinus thrombosis, superior orbital fissure with orbital apex syndrome, aneurysms, brain tumors and other issues such as tuberculosis, fungal, Syphilis and suppurative inflammation of the skull base meningitis. As different etiology, pathogenesis is not the same as the direct tumor compression, primary inflammation, eye movement. Pulley and outreach demyelination of nerve fibers was changed. A clinical performance. Oculomotor nerve palsy performance for ptosis, proptosis slanting upward, on, under, ipsilateral direction of movement disorders, dilated pupils, light reaction and adjustment reaction disappear, the first to the contralateral askew. Complete standstill for more than peripheral, but not complete for more nuclear. 2. Pulley nerve palsy performance not to eyeball downward direction of movement outside, accompanied by diplopia, came downstairs diplopia Obviously, the result is very difficult to move down the stairs. The first was a special place, and which was under the chin down for the first contralateral gesture. 3. Abducens nerve palsy performance for the eyes squint, not outreach, and diplopia. A differential diagnosis. oculomotor nerve palsy (1) Nuclear and beam oculomotor nerve palsy due to brain nuclear occupy in the larger scope, nuclear damage it caused more incomplete paralysis, and most of both sides, we can see neurosyphilis, sausage poisoning and diphtheria. Multi-beam damage caused side oculomotor nerve palsy, ipsilateral pupil performance expanded regulatory function of loss and eyelid ptosis, Eyeball was on the lateral rectus muscle and lateral to the widening and slightly below. 1. Brainstem tumors (tumors of the brain stem) : Clinical characteristics of the performance of the cross-paralysis. that the segmental lesions of the nucleus and the ipsilateral upper sexual cranial nerve damage and the next section of the pyramidal tract contralateral levy. Cranial nerve symptoms of the illness renegade level and scope different. If brain lesions showed more lateral oculomotor nerve palsy, pontine lesions can be in the form of lateral eye outreach and facial paralysis, ipsilateral facial sensory impairment and hearing impairment. Medullary disease, there may be the lateral muscle weakness, paralysis throat and tongue after 1 / 3 taste disappeared. ABR, CT and MRI can clearly diagnose. 2. Brainstem injury (injury of the brain stem) : more than a clear history of trauma, After lengthy injury unconscious and with eye movement disorders, is not difficult to diagnose. 3. Skull base fracture (fracture of the base of the skull) : Traumatic brain injury after carotid artery, have carotid-cavernous fistula appeared restricted eye movement and visual impairment while a head or orbital continuous noise, pulsating exophthalmos. (2) around a paralysis. Skull Base aneurysms (aneurysm of the base of the sk ull) : oculomotor nerve palsy separate arise, the common aneurysm in the skull base and other rare tumors. The disease was mostly seen in young adults, many chronic headache and history of subarachnoid hemorrhage, but also separate the oculomotor nerve palsy emerged. Cerebral angiography can be more clear diagnosis. 2. Intracranial space-occupying lesions (intracranial space occupying lesi on) : Brain Injury increased intracranial pressure and brain tumor late, it has been said has cerebellar tentorium hernia. Performance on the side of the pupil to expand and light reaction disappear, there will be the contralateral limb paralysis, followed contralateral pupil has also expanded. accompanied by disturbance of consciousness. According to history and head CT scans can be more clear diagnosis. 3. Cavernous sinus thrombosis and arterial aneurysm (carernous sinas thoomlosis and inter cavernous sinas aneurysm) : can be in the form of cavernous syndrome, in addition to oculomotor nerve paralysis, there is first the trigeminal nerve damage, orbital soft tissue. The next eyelids, conjunctiva, forehead and scalp nasion congestive edema, or exophthalmos palilledema. inflammation induced who accompanied systemic infection symptoms, combined orbital X-ray and lumbar puncture and blood tests can be diagnosed. 4. Superior orbital fissure with orbital apex syndrome (superior orbital fissure and orb ital apex syndrome) : The former is eye movement, tackle, Outreach nerve and the trigeminal nerve dysfunction first, the latter the only three pairs of cranial nerve damage, accompanied with visual impairment, combined orbital optic hole X-ray, blood tests, such as orbital CT can be more clear diagnosis. 5. Meningitis (cephalitis meningitis) : Meningitis caused by the oculomotor nerve damage mostly bilateral, often with pulleys, while outreach nerve involvement. CSF examination cells, protein increased. 2, the trochlear nerve palsy Trochlear nerve paralysis rarely appeared individually, and many other two pairs of cranial nerves simultaneously involved. Trochlear nerve paralysis, if we do not check diplopia is difficult to identify. The differential diagnosis See oculomotor nerve palsy. 3. abducens nerve palsy (1) Bridge cerebral hemorrhage and tumor (pontine haemonhage and tum our) with the facial nerve in the brain close to the bridge, the two nuclear nerve palsy or beam often exist at the same time, performance on the side of outreach and facial nerve palsy and contralateral hemiplegia. known as the Millard - Gubler's syndrome. Onset often than suddenly and quickly collapsed, double-pupil needle-like change. Based on the clinical performance of CT and MRI diagnosis is not difficult to establish. (2) petrous apex syndrome (radenigo's syndrome) acute otitis media petrous bone apex Bureau limit inflammation and bone sharp rocks can cause meningiomas abducens nerve palsy, and hearing loss associated with the trigeminal nerve and distribution of the pain, called Gradenigo's syndrome; X-ray can be found in bone destruction or inflammatory changes. Combined with the history and CT scan can confirm the diagnosis. (3) nasopharyngeal carcinoma (nasopharynged carcinoma) abducent nerve in front of the skull base was The reasons for the violations of nasopharyngeal cancer the most common, followed by the intracavernous aneurysm and the superior orbital fissure tumors. Middle-aged patients to separate the abducens nerve palsy or a cavernous signs of other manifestations, NPC should first consider the existence. Accompanied epistaxis, nasal obstruction, swelling of the lymph node, for nasopharyngeal biopsy, and the skull base X-ray examination can be diagnosed.