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CN66th Cranial Nerve (abducens)
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3, 4 and 6th cranial nerve palsies can be due to head injury.
In only one patient x-ray skull was abnormal who had bilateral 3,4, and 6th cranial nerve involvement.
In this group, 8 patients had unilateral 3, 4 & 6th cranial nerve involvement.
Among the cranial nerves 3, 4 and 6, commonly affected was the 3rd cranial nerve followed by 4th cranial nerve and 6th cranial nerve.
We think that involvement of the 9th, 10th, and 12th nerves accompanied because our patient had tongue palsy and dysphagia in addition to 7th and 6th cranial nerve palsy,.
Third, 4th, 5th and 6th cranial nerve problems are seen in not only JS but also superior orbital fissure syndrome (also known as Rochon-Duvignaud Syndrome) and cavernous sinus syndrome.3,6 The most common complaints of these three syndromes are retroorbital pain and all are characterised by ophthalmoplegia and ptosis.3,6 Cavernous sinuses contain internal carotid artery and its sympathetic plexus, so orbital congestion and proptosis are seen in cases with cavernous sinus syndrome.
[1] Infection and inflammation of petrous apex involves 6th cranial nerve at the Dorello's canal and 5th cranial nerve in the Meckel's cave.
According to the IHS, OM is diagnosed when at least two or more attacks of migraine-like headaches lasting for 4 days from the onset are accompanied or followed by the paresis of one or more of the third, 4th or 6th cranial nerves. The pathophysiology of OM has yet to be clearly determined.
The regulation of both visual axes and the eccentric fixation is achieved primarily by realignment of the musculoconnective tissue of the eyeballs.5 The protocol may additionally reinforce the function of the retinal photoreceptors, release intracranial entrapment neuropathies of the 3rd, 4th and 6th cranial nerves, strengthen eye-mind correlation, and improve synchronization of the left and right brain hemispheres.
Lateral haemorrhage and necrosis leads to deficits in the 3rd, 4th, 5th (1st and 2nd branches) and 6th cranial nerves.
The trochlear nuclei in the lower midbrain and abducens nuclei in the pons are the origins of the 4th and 6th cranial nerves innervating, respectively, the superior oblique (SO) and lateral rectus (LR) muscles.