Third Nerve Palsy (Oculomotor Nerve Palsy) Follow-up

Updated: Oct 08, 2018
  • Author: James Goodwin, MD; Chief Editor: Andrew G Lee, MD  more...
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Follow-up

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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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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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 recover 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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