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Cn iii compression and fixed dilated pupil12/28/2023 ![]() ![]() Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency,Īrthritis, Shoulder pain, Wasting of the small muscles of the hand ocular prosthesis – the normal pupil may be relatively constricted due to ambient light.Īnosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel visionīronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacementĪtrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC ObstructionĪbdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage.If an acute third nerve palsy is accompanied by pupillary mydriasis an aneurysm arising from the posterior communicating artery must be excluded.parasympathetic nerves are in the superficial parts of the nerve, so tend to be more vulnerable to compressivelesions and spared by vascular lesions (e.g.Oculomotor nerve palsy (3rd cranial nerve).Pharmacological blockade– typically topical mydriatic drugs used to facilitate ophthalomological examinations.Pharmacologic blockade is the most common cause of a fixed dilated pupil in an otherwise normal healthy patient.Ī single fixed dilated (mydriatic) pupil can be caused by: A fixed dilated pupil in an awake patient is NOT due to herniation. Management should include evaluation for mass lesions and/or vascular aetiologies, regardless of pupillary involvement.Suspect herniation due to an intracranial mass lesion as a cause of fixed dilated pupil in an unconscious patient. The associated aetiologies of palsy of cranial nerve three (CN3) carry increased risk of morbidity and mortality. The patient elected against surgery, choosing MRI every six months.ĭue to the subtle clinical presentation of incomplete pupil sparing third nerve palsy, this ophthalmoplegia may be easily overlooked. MRI revealed a cavernous sinus meningioma. Neurological examination revealed a mild deficit in adduction, reduced range of vertical motility and questionable ptosis, all limited to the OD. ![]() We present a 68-year-old hypertensive male complaining of intermittent diplopia for the previous six months. The optometric clinician should be familiar with the association of third nerve palsy with compressive lesions, including the clinical presentations and management of these patients. The diagnosis of incomplete third nerve palsy can be clinically challenging because the aetiologies, as well as presentations, can be variable and subtle. ![]()
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