Bilateral CN VI palsy

Meningitis, AIDP, Wernicke's encephalopathy, pontine glioma

Diagnosis is achieved by assessing the patient's metabolic situation (DM), Diagnosis imaging to exclude tumors or vascular conditions, and checking the CSF and serology for signs of infection.

Convergence spasm Duane's syndrome Internuclear ophthalmoplegia Myasthenia gravis

Pseudo VI nerve palsy (thalamic and subthalamic region) Thyroid disease

Differential diagnosis

Treatment is dependent upon the underlying cause.

Therapy

The most frequent "idiopathic" type in adults usually remits within 4-12 weeks. Prognosis

Galetta SL (1997) III, IV, VI nerve palsies. In: Newman NJ (ed) Neuro-ophthalmology. American Academy of Neurology, Boston, pp 145-33-145-50

Gurinsky JS, Quencer RM, Post MJ (1983) Sixth nerve ophthalmoplegia secondary to a cavernous sinus lesion. J Clin Neuro Ophthalmol 3: 277-281

Lee AG, Brazis PW (2000) Neuro-ophthalmology. In: Evans RW, Baskin DS, Yatsu FM (eds) Prognosis of neurological disorders. Oxford University Press, New York Oxford, pp 97-108 Robertson RM, Hines JD, Rucker CW (1970) Acquired sixth nerve paresis in children. Arch Ophthalmol 83: 574-579

Rucker CW (1966) The causes of paralysis of the third, fourth, and sixth cranial nerves. Am J Ophthalmol 62: 1293-1298

Rush JA, Younge BR (1981) Paralysis of cranial nerves III, IV and VI. Cause and prognosis in 1000 cases. Arch Ophthalmol 99: 76-79

References

Facial nerve

Genetic testing

NCV/EMG

Laboratory

Imaging

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MRI

Clinical exam Taste Hearing

Fig. 10. Facial nerve: 1 Posterior auricular nerve, 2 Mandibular branch, 3 Buccal branch, 4 Zygomatic branch, 5 Temporal branch, 6 Parotid gland

Fig. 11. Facial nerve palsy: This patient suffered from a right sided Bell's palsy, which resulted in a contracture of the facial muscles. Note the deviated mouth

Stapedius, stylohyoid, posterior belly of disgastric, muscles of facial expression, Qualities including buccinator, platysma, and occipitalis muscles. Branchial motor

Lacrimal, submandibular, sublingual glands, as well as mucous membranes of Visceral motor the nose and hard and soft palate.

Skin of concha of auricle, small area of skin behind ear. Trigeminal nerve-V3 General sensory supplies the wall of the acoustic meatus and external tympanic membrane.

Taste of anterior two thirds of tongue and hard and soft palate Special sensory

Large petrosal: salivation and lacrimation Major branches

Nerve to the stapedius muscle

Chorda tympani: taste

Motor branches

Sensory: ear

Branchial motor fibers originate from the facial motor nucleus in the pons, Anatomy lateral and caudal to the VIth nerve nucleus. The fibers exit the nucleus medially, and wrap laterally around the VIth nerve nucleus in an arc called the internal genu. The superior salivatory nucleus is the origin of the preganglionic parasympathetic fibers. The spinal nucleus of the trigeminal nerve is where the small general sensory component synapses. Taste fibers synapse in the rostral gustatory portion of the nucleus solitarius. All four groups of fibers leave the brainstem at the base of the pons and enter the internal auditory meatus. The visceral motor, general sensory, and special sensory fibers collectively form the nervus intermedius. Within the petrous portion of the temporal bone, the nerve swells to form the geniculate ganglion (the site of the cell bodies for the taste and general sensory fibers). The nerve splits within the petrous portion of the temporal bone. First, the greater petrosal nerve carries the parasympathetic fibers to the lacrimal gland and nasal mucosa (the pterygopalatine ganglion is found along its course). The chorda tympani nerve exits through the petrotympanic fissure, and brings parasympathetic fibers to the sublingual and submandibular salivary glands, as well as the taste sensory fibers to the tongue. The nerve to the stapedius innervates the stapedius muscle. The remaining part of the facial nerve, carrying branchial motor and general sensory fibers, exits via the stylomastoid foramen. The motor fibers branch to innervate the facial muscles, with many branches passing through the parotid gland (see Fig. 10).

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