third cranial nerve

第III脳神経、第3脳神経、第三脳神経

関

cranial nerve III、oculomotor nerve

WordNet

1. in the third place; "third we must consider unemployment" (同)thirdly
2. following the second position in an ordering or series; "a distant third"; "he answered the first question willingly, the second reluctantly, and the third with resentment"
3. the musical interval between one note and another three notes away from it; "a simple harmony written in major thirds"
4. coming next after the second and just before the fourth in position (同)3rd, tertiary
5. any bundle of nerve fibers running to various organs and tissues of the body (同)nervus
6. of or relating to the cranium which encloses the brain; "cranial pressure"
7. control of your emotions; "this kind of tension is not good for my nerves"

PrepTutorEJDIC

1. 《the ~》『第3番目の』,3番目の / 3分の1の / 《the ~》『第3』,3番目[のもの],(月の)『3日』 / 〈C〉『3分の1』 / 〈C〉(音楽で)3度[音程] / 〈U〉(自動車などの)サード(第3速)[ギア] / 第3に,3番目に
2. 〈C〉『神経』 / 〈C〉《複数形で》『神経過敏』,いらだち / 〈U〉『勇気』,度胸(courage) / 〈U〉《時にa ~》厚かましさ,ずぶとさ;無礼 / 〈C〉葉脈;(昆虫の)翅脈(しみゃく) / 〈人,特に自分〉‘に'力を与える,‘を'元気づける
3. 頭蓋(ずがい)の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/07/25 22:47:26」(JST)

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Oculomotor nerve
Nerves of the orbit. Seen from above.
Inferior view of the human brain, with the cranial nerves labelled.
Details
From	oculomotor nucleus, Edinger-Westphal nucleus
To	superior branch, inferior branch
Innervates	Superior rectus, Inferior rectus, Medial rectus, Inferior oblique, Levator palpebrae, sphincter pupillae (parasympathetics), ciliaris muscle (parasympathetics)
Identifiers
Latin	nervus oculomotorius
MeSH	A08.800.800.120.600
TA	A14.2.01.007
FMA	50864
Anatomical terms of neuroanatomy

Cranial nerves
CN 0 – Terminal CN I – Olfactory CN II – Optic CN III – Oculomotor CN IV – Trochlear CN V – Trigeminal CN VI – Abducens CN VII – Facial CN VIII – Vestibulocochlear CN IX – Glossopharyngeal CN X – Vagus CN XI – Accessory CN XII – Hypoglossal
Overview Table

The oculomotor nerve is the third cranial nerve. It enters the orbit via the superior orbital fissure and innervates muscles that enable most movements of the eye and that raise the eyelid. The nerve also contains fibers that innervate the muscles that enable pupillary constriction and accommodation (ability to focus on near objects as in reading). The oculomotor nerve is derived from the basal plate of the embryonic midbrain. Cranial nerves IV and VI also participate in control of eye movement.

Structure

The oculomotor nerve originates from the third nerve nucleus at the level of the superior colliculus in the midbrain. The third nerve nucleus is located ventral to the cerebral aqueduct, on the pre-aqueductal grey matter. The fibers from the two third nerve nuclei located laterally on either side of the cerebral aqueduct then pass through the red nucleus. From the red nucleus fibers then pass via the substantia nigra exiting through the interpeduncular fossa.

On emerging from the brainstem, the nerve is invested with a sheath of pia mater, and enclosed in a prolongation from the arachnoid. It passes between the superior cerebellar (below) and posterior cerebral arteries (above), and then pierces the dura mater anterior and lateral to the posterior clinoid process, passing between the free and attached borders of the tentorium cerebelli.

It traverses the cavernous sinus, above the other orbital nerves receiving in its course one or two filaments from the cavernous plexus of the sympathetic nervous system, and a communicating branch from the ophthalmic division of the trigeminal nerve. As the oculomotor nerve enters the orbit it divides into a superior and an inferior branch, which enter the orbit through the superior orbital fissure.

Superior branch

The superior branch of the oculomotor nerve or the superior division, the smaller, passes medially over the optic nerve. It supplies the superior rectus and levator palpebrae superioris.

Inferior branch

The inferior branch of the oculomotor nerve or the inferior division, the larger, divides into three branches.

• One passes beneath the optic nerve to the medial rectus.
• Another, to the inferior rectus.
• The third and longest runs forward between the inferior recti and lateralis to the inferior oblique. From the last a short thick branch is given off to the lower part of the ciliary ganglion, and forms its short root.

All these branches enter the muscles on their ocular surfaces, with the exception of the nerve to the inferior oblique, which enters the muscle at its posterior border.

Nuclei

The oculomotor nerve (CN III) arises from the anterior aspect of mesencephalon (midbrain). There are two nuclei for the oculomotor nerve:

• The oculomotor nucleus originates at the level of the superior colliculus. The muscles it controls are the striated muscle in levator palpebrae superioris and all extraocular muscles except for the superior oblique muscle and the lateral rectus muscle.
• The Edinger-Westphal nucleus supplies parasympathetic fibers to the eye via the ciliary ganglion, and thus controls the sphincter pupillae muscle (affecting pupil constriction) and the ciliary muscle (affecting accommodation).

Sympathetic postganglionic fibres also join the nerve from the plexus on the internal carotid artery in the wall of the cavernous sinus and are distributed through the nerve, e.g., to the smooth muscle of superior tarsal (Mueller's) muscle.

Function

The oculomotor nerve include axons of type GSE, general somatic efferent, which innervate skeletal muscle of the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles.(innervates all the extrinsic muscles except superior oblique and lateral rectus.)

The nerve also includes axons of type GVE, general visceral efferent, which provide preganglionic parasympathetics to the ciliary ganglion. From the ciliary ganglion post ganglionic fibers pass through the short ciliary nerve to the constrictor pupillae of the iris and the cilliary muscles.

Clinical significance

Disease

Paralysis of the oculomotor nerve, i.e., oculomotor nerve palsy, can arise due to:

• direct trauma,
• demyelinating diseases (e.g., multiple sclerosis),
• increased intracranial pressure (leading to uncal herniation)
  • due to a space-occupying lesion (e.g., brain cancer) or a
  • spontaneous subarachnoid haemorrhage (e.g., berry aneurysm), and
• microvascular disease, e.g., diabetes.

In people with diabetes and older than 50 years of age, an oculomotor nerve palsy, in the classical sense, occurs with sparing (or preservation) of the pupillary reflex. This is thought to arise due the anatomical arrangement of the nerve fibers in the oculomotor nerve; fibers controlling the pupillary function are superficial and spared from ischemic injuries typical of diabetes. On the converse, an aneurysm which leads to compression of the oculomotor nerve affects the superficial fibers and manifests as a third nerve palsy with loss of the pupillary reflex (in fact, this third nerve finding is considered to represent an aneurysm—until proven otherwise—and should be investigated).

Examination

Eye muscles

Cranial nerves III, IV, and VI are usually tested together as part of the cranial nerve examination. The examiner typically instructs the patient to hold his head still and follow only with the eyes a finger or penlight that circumscribes a large "H" in front of the patient. By observing the eye movement and eyelids, the examiner is able to obtain more information about the extraocular muscles, the levator palpebrae superioris muscle, and cranial nerves III, IV, and VI. Loss of function of any of the eye muscles results in ophthalmoparesis.

Since the oculomotor nerve controls most of the eye muscles, it may be easier to detect damage to it. Damage to this nerve, termed oculomotor nerve palsy is also known by the down 'n out symptoms, because of the position of the affected eye (lateral, downward deviation of gaze).

Pupillary reflex

The oculomotor nerve also controls the constriction of the pupils and thickening of the lens of the eye. This can be tested in two main ways. By moving a finger toward a person's face to induce accommodation, their pupils should constrict.

Shining a light into one eye should result in equal constriction of the other eye. The neurons in the optic nerve decussate in the optic chiasm with some crossing to the contralateral optic nerve tract. This is the basis of the "swinging-flashlight test".

Loss of accommodation and continued pupillary dilation can indicate the presence of a lesion on the oculumotor nerve.

Additional images

• Map of the oculomotor nerve.

• Median sagittal section of brain.

• Plan of oculomotor nerve.

• Pathways in the Ciliary Ganglion.

See also

This article uses anatomical terminology; for an overview, see Anatomical terminology.

• Anisocoria
• Cranial nerve
• Oculomotor nucleus

References

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

External links

• MedEd at Loyola GrossAnatomy/h_n/cn/cn1/cn3.htm
• oph/183 at eMedicine - "Oculomotor nerve palsy"
• Oculomotor Nerve at the US National Library of Medicine Medical Subject Headings (MeSH)
• hier-479 at NeuroNames
• Animations of extraocular cranial nerve and muscle function and damage (University of Liverpool)
• cranialnerves at The Anatomy Lesson by Wesley Norman (Georgetown University) (III)
• Notes on Oculomotor Nerve

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 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. 複視の概要 overview of diplopia
• 3. 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
• 4. 小児における第4脳神経（滑車神経）麻痺 fourth cranial nerve trochlear nerve palsy in children
• 5. 手術時や麻酔時の成人の体位 patient positioning for surgery and anesthesia in adults

English Journal

• Carotid cavernous sinus fistula caused by dental implant-associated infection.

• Shimizu Y, Tsutsumi S, Yasumoto Y, Ito M.AbstractA 61-year-old woman presented with painful ophthalmoplegia, Tolosa-Hunt syndrome. The patient had undergone a placement of dental implant 5 months before the presentation and had a local maxillary sinusitis 1 month later. She had not been aware of any preceding head trauma or infection. On examination, the patient showed serious right oculomotor nerve paresis and retro-orbital pain. Blood examination showed normal findings. Magnetic resonance imaging identified abnormal structure in the right cavernous sinus with flow void signals. Angiography revealed a carotid cavernous sinus fistula fed by the intracavernous branches of the internal carotid artery on both sides, right internal maxillary and middle meningeal arteries, and left ascending pharyngeal artery. The patient underwent coil embolization via both external carotid arteries. We assumed that local maxillary sinusitis caused by dental implant might spread hematogenously into the sphenoid and cavernous sinuses and formed a carotid cavernous sinus fistula, which presented with Tolosa-Hunt syndrome. Implant-associated infection has to be managed promptly with adequate manner before it spreads.
• American journal of otolaryngology.Am J Otolaryngol.2012 May;33(3):352-5. Epub 2011 Sep 15.
• A 61-year-old woman presented with painful ophthalmoplegia, Tolosa-Hunt syndrome. The patient had undergone a placement of dental implant 5 months before the presentation and had a local maxillary sinusitis 1 month later. She had not been aware of any preceding head trauma or infection. On examinati
• PMID 21924520

• Intraoperative oculomotor nerve monitoring predicts outcome following clipping of posterior communicating artery aneurysms.

• Zhou Q, Zhang M, Jiang Y.SourceDepartment of Neurosurgery, Second Xiangya Hospital of Central South University, 139 Renming Road, Changsha, Hunan Province 410011, China.
• Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2012 May;19(5):706-11. Epub 2012 Mar 27.
• Valid parameters do not exist to predict oculomotor nerve palsy (ONP, ptosis and/or diplopia) intraoperatively. In 49 operations involving 46 patients with posterior communicating artery aneurysms, the oculomotor nerves were stimulated after the aneurysms were clipped. A quantitative analysis of evo
• PMID 22459180

Japanese Journal

• デルファイ法による脳卒中患者に必要なフィジカルアセスメントの検討（第1報）:脳神経に焦点をあてて

• 日本看護科学会誌 35(0), 82-89, 2015
• NAID 130005089303

• 回転性めまいと耳鳴を主訴とした小脳出血の一例

• Equilibrium Research 73(4), 214-219, 2014
• NAID 130004696866

• 頭頚部外科医からみた頭蓋頚椎移行部手術のための神経外科解剖および基本手技

• 脳神経外科ジャーナル 23(2), 121-125, 2014
• NAID 130003397692

Related Pictures

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★リンクテーブル★

リンク元	「第III脳神経」「第3脳神経」「第三脳神経」「cranial nerve III」
関連記事	「cranial」「nerve」

「第III脳神経」

　　[★]

英

cranial nerve III、third cranial nerve

関

動眼神経、第3脳神経、第三脳神経

「第3脳神経」

　　[★]

英

third cranial nerve

関

動眼神経、第III脳神経、第三脳神経

「第三脳神経」

　　[★]

英

third cranial nerve

関

第III脳神経、第3脳神経

「cranial nerve III」

　　[★]

第III脳神経

関

oculomotor nerve、third cranial nerve

「cranial」

　　[★]

• adj.

• 頭蓋の、頭側の

関

cephalad、crania、cranium、rostral、skull

　 　

「nerve」

　　[★]

• n.

• 神経

関

nervi、nervous、nervus、neural、neuro、neuron