Oculomotor nerve

1. Question: What is the definition of the oculomotor (third cranial) nerve?

Answer: The oculomotor (third cranial) nerve is entirely motor in function. It supplies
all the extraocular muscles except the lateral rectus and superior oblique. It also supplies
the intraocular muscles, namely the sphincter pupillae and ciliary muscle.

2. Question: What are the functional components of the oculomotor nerve?

Answer: The oculomotor nerve has three functional components:
- Somatic efferent component: It is responsible for the movements of the eyeball.
- General visceral efferent (parasympathetic) component: It controls accommodation
and contraction of the pupil.
- General somatic afferent component: It receives proprioceptive impulses from the
extraocular muscles supplied by the somatic efferent component of this nerve.

3. Question: What are the components of the oculomotor nuclear complex?

Answer: The oculomotor nuclear complex consists of two main components:
- Main motor nucleus: It is composed of subnuclei supplying individual extraocular
muscles.
- Accessory motor nucleus (Edinger-Westphal nucleus): It sends preganglionic
parasympathetic fibers along the oculomotor fibers.

4. Question: What are the connections of the oculomotor nucleus?

Answer: The oculomotor nucleus is connected with several structures, including the
motor cortex of the cerebral cortex, visual cortex, frontal eye field, nuclei of the fourth,
sixth, and eighth cranial nerves, pretectal nucleus, vertical and torsional gaze centers, and
cerebellum.

5. Question: What is the course and distribution of the oculomotor nerve?

Answer: The oculomotor nerve has three parts:
- Fascicular part: It consists of efferent fibers that pass from the third nerve nucleus
through the midbrain and interpeduncular space.
- Basilar part: It starts as a series of rootlets in the interpeduncular fossa, which
coalesce to form a rounded cord. The nerve then passes between the posterior cerebral
artery and the superior cerebellar artery and runs forward in the interpeduncular cistern to
reach the cavernous sinus.
- Intracavernous part: The nerve enters the cavernous sinus and divides into superior
and inferior divisions, which enter the orbit through the superior orbital fissure.

6. Question: What are the clinical features of complete third nerve palsy?
Answer: Clinical features of complete third nerve palsy include ptosis (drooping of the
eyelid), deviation of the eyeball (down, out, and slightly intorted), restricted ocular
movements, fixed and dilated pupil, complete loss of accommodation, crossed diplopia
(double vision), and specific head posture.
 Oculomotor nerve

7. Question: What are the causes of isolated third nerve palsy?

Answer: The causes of isolated third nerve palsy can include idiopathic (unknown
cause), vascular diseases (such as diabetes and hypertension), trauma, involvement by
extradural hematoma, aneurysms, and other rare causes like tumors or syndromes.

8. Question: What are the various investigations for third nerve palsy?
Answer: The investigations for third nerve palsy can include basic tests such as blood
sugar, blood pressure, lipid profile, and ESR (to rule out giant cell arteritis). Additional
investigations may include X-ray skull lateral view, MRI/MRA, cerebral angiography,
and lumbar puncture.

9. Question: What are the basic investigations recommended for third nerve palsy?
Answer: The basic investigations recommended for third nerve palsy are blood sugar,
blood pressure, lipid profile, and ESR to rule out giant cell arteritis.

10. Question: What imaging techniques can be used to assess third nerve palsy?
Answer: Imaging techniques such as X-ray skull lateral view, MRI/MRA (Magnetic
Resonance Imaging/Magnetic Resonance Angiography), and cerebral angiography can be
used to assess third nerve palsy.

11. Question: When is medical treatment preferred over surgical treatment for third nerve
palsy?
Answer: Medical treatment is preferred over surgical treatment for third nerve palsy in
cases where the underlying cause is manageable with medications and conservative
measures.

12. Question: Which specific muscles are supplied by the oculomotor nerve?
Answer: The oculomotor nerve supplies all the extraocular muscles except the lateral
rectus and superior oblique. It also supplies the intraocular muscles, namely the sphincter
pupillae and ciliary muscle.

13. Question: What is the role of the parasympathetic component of the oculomotor
nerve?
Answer: The parasympathetic component of the oculomotor nerve is responsible for
accommodation and contraction of the pupil.

14. Question: How is the oculomotor nucleus connected to the cerebral cortex?
Answer: The oculomotor nucleus is connected to the cerebral cortex, specifically the
motor cortex (precentral gyrus) of both sides, through the corticonuclear tracts.

15. Question: What is the course of the oculomotor nerve within the cavernous sinus?
Answer: The oculomotor nerve enters the cavernous sinus by piercing the posterior
part of its roof on the lateral side of the posterior clinoid process. It then descends to the
 Oculomotor nerve

lateral wall of the sinus, where it lies above the trochlear nerve. In the anterior part of the
cavernous sinus, the nerve divides into superior and inferior divisions, which enter the
orbit through the middle part of the superior orbital fissure.

16. Question: What are the clinical manifestations of third nerve palsy?
Answer: Clinical manifestations of third nerve palsy include ptosis (drooping of the
eyelid), deviation of the eyeball (down, out, and slightly intorted), restricted ocular
movements, fixed and dilated pupil, complete loss of accommodation, crossed diplopia
(double vision), and specific head posture.

17. Question: What are some common medical causes of pupil-sparing isolated third
nerve palsy?
Answer: The document does not provide specific information about common medical
causes of pupil-sparing isolated third nerve palsy.

18. Question: How can trauma cause isolated third nerve paralysis?
Answer: Trauma can cause isolated third nerve paralysis by direct injury to the
oculomotor nerve or its nucleus, compression due to hematoma or edema, or stretching of
the nerve.

19. Question: What are the mechanisms of third nerve involvement by an extradural
hematoma?
Answer: The document does not provide specific information about the mechanisms of
third nerve involvement by an extradural hematoma.

20. Question: What are some rare causes of painful third nerve palsy?
Answer: The document does not provide specific information about rare causes of
painful third nerve palsy.

21. Question: What are the recommended investigations for diagnosing third nerve palsy?
Answer: Recommended investigations for diagnosing third nerve palsy may include
basic tests such as blood sugar, blood pressure, lipid profile, and ESR (to rule out giant
cell arteritis). Additional investigations may include X-ray skull lateral view, MRI/MRA,
cerebral angiography, and lumbar puncture.

22. Question: How does a lateral view skull X-ray help in ruling out sellar lesions
involving the cavernous sinus?
Answer: The document does not mention how a lateral view skull X-ray helps in ruling
out sellar lesions involving the cavernous sinus.

23. Question: What is the significance of medical treatment compared to surgical

treatment for third nerve palsy?
 Oculomotor nerve

Answer: The document does not specifically discuss the significance of medical
treatment compared to surgical treatment for third nerve palsy. Additional information or
clinical context may be needed to provide a more specific answer.