New: NCI-funded clinical trial search
Mednet Logo

How would you work up and manage an isolated CN3 deficit with anisocoria?

MRI Orbits with possible mild enhancement of unilateral CN3; Brain MRI chronic microvascular disease, mild atrophy.
2 Answers
Mednet MemberInvited Expert
Neurology · UVA Health
Answered on

This question proposes an isolated CN 3 deficit, with almost no other clinical information.

(Just as an aside, it would be important to note whether there is any evidence of aberrant regeneration of CN 3 and also check to make sure that there is no involvement of CN 4, which would immediately shift the differential toward aneurysmal compression in case of the former or shift localization to the cavernous sinus in case of the latter).

The differential diagnosis of a truly isolated pupil-involving CN III palsy is fairly broad.

Whether the ocular motor deficits are complete or incomplete, it would be important to first rule out aneurysmal compression (most commonly by a PComm aneurysm) of CN 3 with some form of vessel imaging (for example, hig...

Join for free or sign in to see the full answer

Mednet Member
Neurology · University of Minnesota
Answered on

This is an interesting question and of course, depends on how "complete" the Cranial Nerve III is. The above differential diagnosis is excellent: "If there is no evidence of any structural lesion, then I would consider the possibility of inflammatory, infectious, or ischemic etiologies for the CN 3 palsy." I presume this includes diabetes.

Join for free or sign in to see the full answer