Oculomotor Nerve Palsy Follow-up

  • Author: James Goodwin, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Dec 18, 2009
 

Further Inpatient Care

  • Inpatient management of berry aneurysm is up to the discretion of the neurosurgeon.
  • There are no ophthalmological indications for inpatient care.
  • Management of meningitis or systemic cancer may require inpatient care at the discretion of the internist, neurologist, or oncologist treating the case.
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Further Outpatient Care

  • Ophthalmologic outpatient follow-up care is the routine for patients with ischemic (pupil-sparing) third cranial nerve palsy.
    • These patients should have routine visits every month or so until the palsy remits. This is mainly to provide symptomatic intervention as is warranted at different stages and to document eventual recovery.
    • Patients who do not recover function after 12-16 weeks may need further diagnostic workup to look for alternative diagnoses.
    • Long-term follow-up care is mainly for those patients who do not recover and for those patients who may require eye muscle surgery for residual, stable diplopia or ptosis.
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Complications

  • Sudden full rupture of berry aneurysm with massive subarachnoid hemorrhage may lead to devastating neurologic deficit and death.
    • This rupture is one of the most serious emergencies that patients presenting with isolated third cranial nerve palsy may develop, and it constitutes the compelling reason for careful differential diagnosis.
    • In much the same way, the natural history of all the diseases mentioned in this article might be listed as complications of third cranial nerve palsy but will not be further elaborated here.
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Prognosis

  • The prognosis depends upon the etiological diagnosis in the individual case. Medical third cranial nerve palsy from presumed ischemia carries the best prognosis for recovery of nerve function, as almost all of these patients recovery spontaneously within a few weeks.
  • Patients with third cranial nerve palsy from identifiable diseases, such as infectious or neoplastic meningeal infiltration and berry aneurysm, have varying prognosis depending on a myriad of factors that are beyond the scope of this article.
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Contributor Information and Disclosures
Author

James Goodwin, MD  Associate Professor, Departments of Neurology and Ophthalmology, University of Illinois College of Medicine; Director, Neuro-Ophthalmology Service, University of Illinois Eye and Ear Infirmary

James Goodwin, MD is a member of the following medical societies: American Academy of Neurology, Illinois State Medical Society, North American Neuro-Ophthalmology Society, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Edsel Ing, MD, FRCSC  Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Toronto East General Hospital, Canada

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Angiography anteroposterior and lateral views, left posterior communicating artery aneurysm, indicated by red arrow. Courtesy of James Goodwin, MD.
Patient with left posterior communicating artery aneurysm and third cranial nerve palsy. Courtesy of James Goodwin, MD.
 
 
 
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