THIRD-NERVE PALSY WITH SPARING OF PUPIL IN DIABETES MELLITUS

Intracranial aneurysms with superior division paresis of the oculomotor nerve

Five patients with intracranial aneurysms had unilateral ptosis, limitation of supraduction, and normal pupillary reactivity. The most common aneurysm location for superior division paresis of the oculomotor nerve was the superior cerebellar-posterior cerebral artery junction, where aneurysms (3) of the basilar artery compressed and flattened the interpeduncular oculomotor nerve from below. A superior cerebellar artery aneurysm and brain stem infarction affected the intra-axial course of the oculomotor nerve producing superior division paresis. Only an aneurysm of the intracavernous carotid artery resulted in superior division paresis at the expected anatomic site of bifurcation of the oculomotor nerve into its superior and inferior divisions. Because the superior division supplies innervation exclusively to the superior rectus muscle and levator palpebrae, an aneurysm involving this branch does not affect the pupillo-constrictor fibers. Consequently, cerebral angiography should be considered in the initial evaluation of this ocular motor deficit.

Simultaneous, bilateral diabetic ophthalmoplegia. Report of two cases and discussion of differential diagnosis

Two patients presented with simultaneous oculomotor nerve palsies clinically associated with diabetes mellitus. Although unilateral cranial nerve palsies frequently occur in diabetes mellitus, this report is the first documented occurrence of simultaneous, concurrent diabetic (vasculopathic) oculomotor nerve palsies. The differential diagnosis of bilateral ophthalmoplegia is discussed in detail.

Cranial nerve damage in patients after alpha (heavy)-particle radiation to the pituitary

The records of 161 patients were reviewed to determine if radiation damage had occurred following cranial irradiation. All of these patients had received alpha-particle radiation to their pituitary glands during the period when this form of therapy was given for diabetic retinopathy. Extraocular muscle palsy developed in 11 of these patients, iridoplegia in six, and fifth nerve damage in six. All of the palsies developed within a short period following their irradiation, and a definite dose relationship was present. The dose rate was approximately 100 rads/min for all cases. Fractionation varied but it is known for all cases. The estimated doses to the third, fourth, fifth, and sixth cranial nerves was calculated at a saggital plane 13 to 15 mm from the pituitary by using computer-drawn dosimetry charts for the respective aperture size. The energetic alpha particles were produced by the 184-in synchrocyclotron at Berkeley, Calif. A dose relationship for radiation palsies was apparent.

Third nerve regeneration; a clinical evaluation

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