Which specialist consultations are indicated in the treatment of 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

Internal medicine

Initial workup of pupil-sparing, third cranial nerve palsy without any other evidence of aneurysm involves medical evaluation for arteriosclerotic risk factors, including diabetes and hypertension.

Certain patients may require screening for collagen vascular disease, systemic vasculitis, sarcoidosis, or other granulomatous systemic diseases.

If carcinomatous meningitis is diagnosed on cerebrospinal fluid workup, then a search for systemic metastatic disease, an occult primary carcinoma, lymphoma, or leukemia is warranted.

Neurosurgery

Third cranial nerve palsy due to berry aneurysm, with or without concomitant subarachnoid hemorrhage, requires neurosurgical management in most cases.

Ophthalmology

The ophthalmologist provides symptomatic treatment for diplopia using occlusion, prism, or eye muscle surgery, and various lid-lift procedures for ptosis.


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