What causes fascicular third cranial nerve palsy (oculomotor cranial nerve palsy)?

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

Fascicular midbrain portion

  • Infarction
  • Hemorrhage
  • Neoplasm
  • Abscess

Subarachnoid portion

  • Aneurysm
  • Infectious meningitis - Bacterial, fungal/parasitic, viral
  • Meningeal infiltrative
  • Carcinomatous/lymphomatous/leukemic infiltration, granulomatous inflammation (sarcoidosis, lymphomatoid granulomatosis, Wegener granulomatosis) [22]
  • Ophthalmoplegic migraine

Cavernous sinus portion

  • Tumor - Pituitary adenoma, meningioma, craniopharyngioma, metastatic carcinoma
  • Pituitary apoplexy (infarction within existing pituitary adenoma) [23]
  • Vascular
  • Giant intracavernous aneurysm
  • Carotid artery-cavernous sinus fistula
  • Carotid dural branch-cavernous sinus fistula
  • Cavernous sinus thrombosis
  • Ischemia from microvascular disease in vasa nervosa
  • Inflammatory - Tolosa-Hunt syndrome (idiopathic or granulomatous inflammation)

Orbital portion

  • Inflammatory - Idiopathic orbital inflammatory syndrome (orbital pseudotumor, orbital myositis)
  • Endocrine (thyroid orbitopathy mimicking third nerve palsy)
  • Tumor (eg, hemangioma, lymphangioma, meningioma)

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