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Third nerve palsy finding
This person has a complete right third nerve palsy with ptosis, impaired eye movements and a dilated pupil.
About third nerve palsy
Patients with a third nerve palsy most often have ptosis and vertical diplopia, double vision in which one image is higher than the other. The ptosis of the third nerve palsy is due to weakness of the upper lid and often is severe enough to cover the pupil and eliminate the symptom of double vision. The diplopia occurs due to weakness of elevation, depression and adduction of the affected eye, resulting in down-and-out eye deviation in primary gaze. These patients may have a dilated pupil with poor light response due to involvement of the parasympathetic fibers.
Localization
The third cranial nerve originates in the midbrain. It has an oculomotor and a parasympathetic nerve component. The oculomotor component innervates the levator palpebrae of the upper eyelid and four extraocular muscles: the superior rectus, the medial rectus, the inferior rectus and the inferior oblique. Weakness of these muscles causes disconjugate gaze and result in diplopia that improves with one eye closed. The parasympathetic fibers that constrict the pupil travel on the surface of the oculomotor component of the nerve. Consequently, compressive lesions may preferentially involve the pupil, while lesions intrinsic to the oculomotor nerve, such as diabetic vasculopathy, tend to spare the pupil.
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