WordNet

a condition marked by uncontrollable tremor
affect with palsy
become friends; act friendly towards (同)pal up, chum up
supplies extrinsic muscles of the eye (同)oculomotor_nerve, nervus_oculomotorius, third_cranial_nerve

PrepTutorEJDIC

麻痺(まひ),中風 / …‘を'麻痺させる(paralyze)
《話》『友達』,仲間,親友 / (…と)仲よくなる《[『up』]『with』+『名』》

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/07 22:49:04」(JST)

wiki en

Oculomotor nerve palsy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. As the name suggests, the oculomotor nerve supplies the majority of the muscles controlling eye movements. Thus, damage to this nerve will result in the affected individual being unable to move his or her eye normally. In addition, the nerve also supplies the upper eyelid muscle (Levator palpebrae superioris) and the muscles responsible for pupil constriction (sphincter pupillae) . The limitations of eye movements resulting from the condition are generally so severe that the affected individual is unable to maintain normal alignment of their eyes when looking straight ahead, leading to strabismus and, as a consequence, double vision (diplopia).

It is also known as "Oculomotor neuropathy".^[1]

Eye Position

A complete Oculomotor nerve palsy will result in a characteristic down and out position in the affected eye. The eye will be displaced outward and displaced downward; outward because the lateral rectus (innervated by the sixth cranial nerve) maintains muscle tone in comparison to the paralyzed medial rectus. The eye will be displaced downward, because the superior oblique (innervated by the fourth cranial or trochlear nerve), is unantagonized by the paralyzed superior rectus, inferior rectus and inferior oblique. The affected individual will also have a ptosis, or drooping of the eyelid, and mydriasis (pupil dilation).

It should be borne in mind, however, that the branched structure of the oculomotor nerve means that damage sustained at different points along its pathway, or damage caused in different ways (compression versus loss of blood supply, for example), will result in different muscle groups or, indeed, different individual muscles being affected, thus producing different presentation patterns.

Compressive oculomotor nerve damage could result in compression of the parasympathetic fibers before any disruption of the motor fibers occurs, since the parasympathetic fibers run on the outside of the nerve. Therefore, one could have lid ptosis and mydriasis (a "blown" pupil) as a result of parasympathetic fiber compression before the "down and out" position is seen.

Cause

Oculomotor palsy can arise as a result of a number of different conditions. Non traumatic pupil-sparing oculomotor nerve palsies are often referred to as a 'medical third' with those affecting the pupil being known as a 'surgical third'.

Congenital Oculomotor Palsy

The origins of the vast majority of congenital oculomotor palsies are unknown, or idiopathic to use the medical term. There is some evidence of a familial tendency to the condition, particularly to a partial palsy involving the superior division of the nerve with an autosomal recessive inheritance. The condition can also result from aplasia or hypoplasia of one or more of the muscles supplied by the oculomotor nerve. It can also occur as a consequence of severe birth trauma.

Acquired oculomotor palsy

1. Vascular disorders such as diabetes, heart disease, atherosclerosis and aneurysm, particularly of the posterior communicating artery
2. Space occupying lesions or tumours, both malignant and non-malignant
3. Inflammation and Infection
4. Trauma
5. Demyelinating disease (Multiple sclerosis)
6. Autoimmune disorders such as Myasthenia gravis
7. Post operatively as a complication of neurosurgery
8. Cavernous sinus thrombosis

Ischemic insult selectively affects somatic fibers over parasympathetic fibers, while traumatic insult affects both types more equally. Therefore, while almost all forms cause ptosis and impaired movement of the eye, pupillary abnormalities are more commonly associated with trauma than with ischemia.

Oculomotor palsy can be of acute onset over hours with symptoms of headache when associated with diabetes Mellitus. Diabetic neuropathy of the oculomotor nerve in a majority of cases does not affect the pupil.^[2] The sparing of the pupil is thought to be associated with the microfasciculation of the edge fibers which control the pupillomotor fibers, which control the pupil.^[3]

References

^ Mohammad, J; Kefah, AH; Abdel, Aziz H (2008). "Oculomotor neuropathy following tetanus toxoid injection". Neurol India 56 (2): 214–6. doi:10.4103/0028-3886.42013. PMID 18688160.
^ Goldstein, JE (1960). "Diabetic opthalmopegia with special reference to the pupil". Arch Opthalmol 64: 592.
^ Dyck; Thomas (1999). Diabetic Neuropathy: 458–459. Missing or empty |title= (help)

External links

Pituitary Apoplexy Presenting as Acute Painful Isolated Unilateral Third Cranial Nerve Palsy on ams.ac.ir

UpToDate Contents

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1. 成人における第三脳神経（動眼神経）麻痺 third cranial nerve oculomotor nerve palsy in adults
2. 小児における第3脳神経（動眼神経）麻痺 third cranial nerve oculomotor nerve palsy in children
3. Neonatal brachial plexus palsy
4. 小児における垂直斜視の原因 causes of vertical strabismus in children
5. 進行性核上性麻痺（PSP） progressive supranuclear palsy psp

English Journal

Treatment of acromegaly patients with risk-adapted single or fractionated stereotactic high-precision radiotherapy : High local control and low toxicity in a pooled series.

Boström JP1, Kinfe T, Meyer A, Pintea B, Gerlach R, Surber G, Lammering G, Hamm K.
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al].Strahlenther Onkol.2015 Jan 10. [Epub ahead of print]
PURPOSE: The purpose of this work was to evaluate a prospectively initiated two-center protocol of risk-adapted stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) in patients with acromegaly.PATIENTS AND METHODS: In total 35 patients (16 men/19 women, mean age 54 years) were prospec
PMID 25575977

Case of Behçet's disease complicated by oculomotor nerve palsy associated with internal carotid artery-posterior communicating artery aneurysm.

Yamaoka T1, Murota H, Katayama I.
The Journal of dermatology.J Dermatol.2015 Jan 9. doi: 10.1111/1346-8138.12752. [Epub ahead of print]
Behçet's disease (BD) is a relapsing systemic inflammatory disorder of unknown etiology involving systemic vasculitis. Vasculitis in BD results from the involvement of arteries, veins and blood vessels of all sizes, which leads to the three major manifestations of this condition: venous occlusion,
PMID 25573207

The Expanding Spectrum of Neurological Phenotypes in Children With ATP1A3 Mutations, Alternating Hemiplegia of Childhood, Rapid-onset Dystonia-Parkinsonism, CAPOS and Beyond.

Sweney MT1, Newcomb TM2, Swoboda KJ3.
Pediatric neurology.Pediatr Neurol.2015 Jan;52(1):56-64. doi: 10.1016/j.pediatrneurol.2014.09.015. Epub 2014 Oct 13.
BACKGROUND: ATP1A3 mutations have now been recognized in infants and children presenting with a diverse group of neurological phenotypes, including Rapid-onset Dystonia-Parkinsonism (RDP), Alternating Hemiplegia of Childhood (AHC), and most recently, Cerebellar ataxia, Areflexia, Pes cavus, Optic at
PMID 25447930

Japanese Journal

臨床報告動眼神経麻痺を合併した側頭動脈炎の1例

眞鍋歩,加島陽二,蓮見禎行 [他]
眼科 54(8), 1065-1070, 2012-08
NAID 40019405692

Pituitary Apoplexy Presenting Atypical Time Course of Ophthalmic Symptoms

ENATSU Rei,ASAHI Minoru,MATSUMOTO Masato,HIRAI Osamu
Tohoku journal of experimental medicine 227(1), 59-61, 2012-05-01
NAID 10030613241

Pupil-Sparing Oculomotor Nerve Palsy Caused by Upward Compression of a Large Posterior Communicationg Artery Aneurysm : Case Report

MOTOYAMA Yasushi,NONAKA Junichi,HIRONAKA Yasuo,PARK Young-Soo,NAKASE Hiroyuki
Neurologia medico-chirurgica = 神経外科 52(4), 202-205, 2012-04-15
… A 69-year-old woman without diabetes or hypertension presented with a large posterior communicating artery aneurysm projecting beneath the oculomotor nerve manifesting as a 2-week history of progressive diplopia. … Craniotomy and neck clipping of the aneurysm revealed the origin at the junction of the internal carotid artery and posterior communicating artery, and elevation of the oculomotor nerve. …
NAID 10030127776

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★リンクテーブル★

リンク元	「動眼神経麻痺」
関連記事	「palsy」「oculomotor」

「動眼神経麻痺」

Oculomotor nerve palsy
	Eye nerves diagram
Classification and external resources
ICD-10	H49.0
ICD-9	378.52
DiseasesDB	2861
eMedicine	oph/183
MeSH	D015840

　　[★]

英: oculomotor nerve paralysis, oculomotor paralysis, oculomotor palsy
ラ: paralysis oculomotoria
関: 動眼神経

概念

動眼神経の麻痺

病因

脳動脈瘤：内頚動脈、内頚動脈後交通動脈分岐部動脈瘤、脳底動脈・上小脳動脈分岐部の動脈瘤

瘤

動脈硬化症
腫瘍：
糖尿病：
髄膜炎
外傷

症状

神経		筋肉	作用
動眼神経	CN III	内直筋		内転
外転神経	CN VI	外直筋		外転
動眼神経	CN III	上直筋	上転	内転	内旋
動眼神経	CN III	下直筋	下転	内転	外旋
動眼神経	CN III	下斜筋	上転	外転	外旋
滑車神経	CN IV	上斜筋	下転	外転	内旋