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CN33rd Cranial Nerve (oculomotor)
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Among the cranial nerves 3, 4 and 6, commonly affected was the 3rd cranial nerve followed by 4th cranial nerve and 6th cranial nerve.
During follow-up period of 2 months, her facial pain, her facial paralysis, and her eye movements especially related to the 3rd cranial nerve improved partially.
Diplopia may occur due to cranial nerve palsies--the 6th cranial nerve is particularly vulnerable to stretch while the 3rd cranial nerve is at risk because herniation of the medial temporal lobe through the tentorial notch stretches the nerve as it exits the midbrain.
Our patient had coma, left 3rd cranial nerve palsy and abnormal oculocephalic response with vertical gaze palsy (3,4).
The fasciculated axons of the 3rd cranial nerve initially traverse the MLF when leaving the oculomotor complex, diverge as they pass through the red nucleus, and then converge prior to exiting the anterior surface of the upper midbrain (Figure 3).
If they complain of large pupils, think about 3rd cranial nerve palsy, Adie's pupil (tonic pupil syndrome), trauma, uveitis, or a pharmacologic cause.
* Other Neurological evaluation/ other cranial nerves/ sensory and motor system intact/No other deficit noted other than 3rd cranial nerve palsy.
Tuberculous Meningitis was the most common cause of the chronic meningitis affecting the 6th and 3rd cranial nerves more frequently.