What are the symptoms of oculomotor nerve palsy due to lesions in the fascicular midbrain portion of the third cranial nerve?

Updated: Oct 08, 2018
  • Author: James Goodwin, MD; Chief Editor: Andrew G Lee, MD  more...
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Answer

Lesions in the fascicular midbrain portion can lead to complete or incomplete palsies that may be indistinguishable from lesions outside the midbrain. Because of the proximity of the fascicular portion of the nerve to other structures in the midbrain, lesions typically produce neurologic symptoms associated with the damaged structures. Several syndromes have been recognized and are described below.

Nothnagel syndrome, which results from a lesion involving the fascicles and the superior cerebellar peduncle, includes third cranial nerve palsy and ipsilateral cerebellar ataxia.

Claude syndrome, although caused by involvement of the same structures as Nothnagel syndrome, includes third cranial nerve palsy and contralateral cerebellar ataxia. [2]

Benedikt syndrome results from involvement of the fascicles and the red nucleus and includes third cranial nerve palsy, ipsilateral flapping hand tremor (rubral tremor), and ataxia.

Weber syndrome results from a slightly more ventral lesion at the level of the fascicles in the midbrain with involvement of the cerebral peduncle, giving rise to third cranial nerve palsy along with contralateral hemiplegia or hemiparesis.


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