Differential Diagnosis - Pacific University
Differential Diagnosis - Pacific University
Differential Diagnosis - Pacific University
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5/29/2012<br />
CN III aberrant regeneration<br />
Fibers making incorrect connections<br />
Can occur from the following<br />
Congenital<br />
Primary<br />
Acquired… damage or compression<br />
• During recovery<br />
• NOT ISCHEMIC!!!<br />
CN III aberrant regeneration<br />
1. Pseudo graefe sign<br />
levator superioris and inferior rectus<br />
2. Eyelid dyskinesis<br />
levator superioris and medial rectus<br />
3. Pupil dyskinesis<br />
parasympathetic fibers and medial rectus<br />
Food for thought<br />
86% of pupil involved are from aneurysms<br />
23% of pupil involved are vascular/ischemic<br />
14% of pupil sparing are from aneurysms<br />
77% of pupil sparing are vascular/ischemic<br />
Food for thought<br />
95% of painful CN III palsies are caused by<br />
aneurysms<br />
80% of painful CN III palsies are ischemic/vascular<br />
Pain not a very good differential<br />
Kissel JT. Ann Neurol 1983<br />
Goldstein JE, et al. Arch Ophthalmol 1960<br />
Clinical Pearls<br />
Questions<br />
<br />
<br />
<br />
<br />
<br />
Case history<br />
Investigate the double vision<br />
• Monocular or binocular<br />
• Vertical or horizontal<br />
• Distance or at near<br />
Comitant or non-comitant<br />
Forced duction testing!<br />
Photo document<br />
Don’t forget imaging guidelines<br />
Can be an ocular emergency!!<br />
Send for proper referrals<br />
Atypical cases… not all are textbook<br />
Special thanks to:<br />
Curtis Manning, MD<br />
Paul W Hiss, MD<br />
Douglas Devries, OD<br />
Gerard L Hershewe, DO<br />
Jarl Nielsen, MD<br />
Coursebook Page 35 of 139<br />
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