An acute third nerve palsy should raise concern of an intracerebral aneurysm, most commonly expansion of a posterior communicating artery aneurysm. If the diagnosis of subarachnoid hemorrhage is entertained, then a computed tomography scan (with lumbar puncture if the scan is negative) should be performed. A brain tumor presentation can include a third nerve palsy, although the duration of symptoms would typically be longer, and other findings would ordinarily be present. Horners syndromeptosis, myosis, and anhydrosisshould prompt a work-up for a thoracic or neck mass, carotid dissection, or another condition that can interrupt sympathetic innervation. Cavernous sinus thrombosis usually follows a facial or sinus infection. Although, this condition can include a third nerve palsy, a sixth nerve palsy is much more common. Although there can be many ocular presentations of multiple sclerosis, optic neuritis with pain and decreased visual acuity would be a more typical presentation.
- Cerebral aneurysm.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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