Paresen okulomotorischer Hirnnerven

Abstract

Patients with oculomotor, trochlear, or abducens nerve palsies mainly complain of binocular double vision, but sometimes merely of blurred vision or vertigo. The clinical signs comprise strabismus, pathologic head posture, and disturbed saccades. The characteristic motility deficits are picked up by measuring the strabismic angles at different directions of gaze. Documentation of all three spatial strabismic components is advantageous. Nonparetic strabismus and orbital diseases are important differential diagnoses. Conclusions about the cause of a palsy can be drawn from the time course of double vision, the character of associated headaches, the patient's general risk factors, and the examination of vicinal structures. Imaging studies are indicated when the ischemic nature of the palsy is in doubt. Therapeutic strategies include prisms, occlusion, and eye-muscle surgery.

Infranuclear Eye Movement Disorders

“…Binocular diplopia is the subjective leading symptom [2], although this does not necessarily occur [5]. The diplopia is sometimes perceived at the outset, but usually only in the course of the movement disorder.…”

“…Targeted questioning is designed to detect blurred vision [5], glare sensitivity, binocular orientation problems or loss of stereopsis.…”

“…The dynamics of the symptoms can also differ greatly (▶ Fig. 1), depending on whether the underlying cause is ischaemia, decompensated phoria or a tumour for example [5].…”

“…Oculomotor nerve palsy involving the pupillomotor is regarded as an emergency. As such imaging using an MRI scan with a contrast dye is recommended for oculomotor nerve palsies involving the pupil [5,9].…”

Akute Doppelbilder: Differenzialdiagnose, Abklärung und Behandlungsoptionen

“…▶ Abb. 2 liefert ein pragmatisches Überblicksschema zur Abklärung erworbener, isolierter okulomotorischer Hirnnervenparesen auf der Basis der Empfehlungen von Staubach et al[7] und Besch et al[8].Abduzensparese (HN VI) Der N. abducens innerviert den M. rectus lateralis und führt dementsprechend bei einer Parese zu einer Abduktionseinschränkung am betroffenen Auge. Klinisch zeigt sich je nach Ausprägungsgrad eine Esotropie mit Zunahme des Schielwinkels in Abduktion und dementsprechend Wahrnehmung ungekreuzter horizontaler Doppelbilder größeren Abstands zueinander in Abduktion des betroffenen Auges.…”