Case 182 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 182 Answers

1. Do the left eye signs and symptoms in this case indicate involvement of the sympathetic nervous system, parasympathetic nervous system, brain stem, a cranial nerve or nerves, an extraocular muscle or muscles, or a disorder of neuromuscular transmission? Cite the evidence supporting your conclusion.

Left oculomotor nerve (III) palsy. No ANS signs/symptoms, no other brain stem symptoms, all other ocular muscles, except the left IIIrd nerve muscles, are intact.

2. Do you think this patient’s headache problem is due to a serious or structural problem or a more benign process?

Probably due to an ischemic oculomotor nerve lesion

3. Indicate the specific structures involved by the pathologic process in this case and the most likely anatomical location of the lesion.

Left oculomotor nerve (III), outside the CNS

4. In general, what type of pathologic process is involved in this case?

Vascular – ischemic insult of the nerve due to small vessel disease

5. At this point what would be your working diagnosis? What other diagnoses would you consider?

Ischemic oculomotor nerve palsy due to diabetic vasculopathy. (DDx: autoimmune disease, basilar meningitis, ophthalmoplegic migraine, Tolosa Hunt syndrome. Less likely to be a compressive lesion due to the lack of pupillary dilation.)

6. What diagnostic procedure(s) would you undertake at this point?

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