GuidelinesOther guideline
Acute Third Nerve Palsy
Acute Third Nerve Palsy
Key history
- Duration
- Age
- Associated headache/pain
- Systemic disease especially diabetes and hypertension
- Family history – cerebral bleeds or CVA
Key examination
DO
- Visual acuity on both eyes
LOOK FOR
- Partial or complete ptosis
- Pupil involvement – dilated or not
- Eye movements – typically all reduced except lateral gaze leaving eye in outward depressed position
Referral
- Partial (not full) ptosis or pupil involvement palsy requires urgent neuroimaging (CT angiogram or MRA) to exclude compressing intra-cerebral aneurysm
- Complete pupil sparing palsy in patients over 50 years with cardiovascular risk factors should be referred semi-urgently
- IF UNSURE, DISCUSS WITH OPHTHALMOLOGY or neurosurgery