TY - JOUR
T1 - Superior divisional third cranial nerve paresis
T2 - Clinical and anatomical observations of 2 unique cases
AU - Bhatti, M. Tariq
AU - Eisenschenk, Stephen
AU - Roper, Steven N.
AU - Guy, John R.
PY - 2006/5
Y1 - 2006/5
N2 - Background: Within the midbrain, the third nerve nucleus is composed of a complex of subnuclei. The fascicular portion of the nerve courses through the red nucleus and exists in the midbrain just medial to the cerebral peduncle. The cisternal portion of the nerve is a single structure that divides into a superior branch and an inferior branch in the region of the cavernous sinus and superior orbital fissure. Objective: To describe 2 patients with superior divisional third cranial nerve paresis resulting from a lesion involving the cisternal portion of the nerve prior to its anatomical bifurcation. Patients: Case 1 was a 77-year-old man with a superior divisional third nerve palsy as the presenting manifestation of a posterior communicating artery aneurysm. Case 2 was a 41-year-old woman who developed a superior divisional third nerve palsy following anterior temporal lobectomy for epilepsy. Results: In both cases, the presumed location of the lesion was the cisternal portion of the third cranial nerve. Conclusions: Although the anatomical division of the third cranial nerve occurs in the region of the anterior cavernous sinus or superior orbital fissure, there is a topographical arrangement of the motor fibers within the cisternal portion of the nerve. The clinical evaluation of a patient with a third cranial nerve paresis requires an understanding of the regional neuroanatomy and topographical organization of the nerve.
AB - Background: Within the midbrain, the third nerve nucleus is composed of a complex of subnuclei. The fascicular portion of the nerve courses through the red nucleus and exists in the midbrain just medial to the cerebral peduncle. The cisternal portion of the nerve is a single structure that divides into a superior branch and an inferior branch in the region of the cavernous sinus and superior orbital fissure. Objective: To describe 2 patients with superior divisional third cranial nerve paresis resulting from a lesion involving the cisternal portion of the nerve prior to its anatomical bifurcation. Patients: Case 1 was a 77-year-old man with a superior divisional third nerve palsy as the presenting manifestation of a posterior communicating artery aneurysm. Case 2 was a 41-year-old woman who developed a superior divisional third nerve palsy following anterior temporal lobectomy for epilepsy. Results: In both cases, the presumed location of the lesion was the cisternal portion of the third cranial nerve. Conclusions: Although the anatomical division of the third cranial nerve occurs in the region of the anterior cavernous sinus or superior orbital fissure, there is a topographical arrangement of the motor fibers within the cisternal portion of the nerve. The clinical evaluation of a patient with a third cranial nerve paresis requires an understanding of the regional neuroanatomy and topographical organization of the nerve.
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U2 - 10.1001/archneur.63.5.771
DO - 10.1001/archneur.63.5.771
M3 - Article
C2 - 16682550
AN - SCOPUS:33646413133
VL - 63
SP - 771
EP - 776
JO - Archives of Neurology
JF - Archives of Neurology
SN - 0003-9942
IS - 5
ER -