Isolated pupil-sparing third nerve palsy.
The challenge in managing patients with pupil-sparing third nerve palsies is met most efficiently by dividing such patients into three groups according to the relative deficits in pupillomotor and extraocular muscle function: (1) patients with a normal pupillary sphincter and completely palsied extraocular muscles. Such patients should not have cerebral angiography if they are aged 50 or more; (2) patients with a normal pupillary sphincter and incompletely palsied extraocular muscles. Such patients should have angiography, particularly if the inferior oculomotor division is spared; (3) patients with a subnormal pupillary sphincter and completely palsied extraocular muscles ("relative pupil-sparing"). Such patients should have angiography unless they have clear-cut vasculopathic findings.
D000368:Aged; D002533:Cerebral Angiography; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D007498:Iris / Q000294:innervation*; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000209:etiology; D009802:Oculomotor Nerve / Q000503:physiopathology; D009886:Ophthalmoplegia / Q000209:etiology*; D012025:Reflex, Pupillary