THE ABDUCENS NERVE (CN VI) |
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The Origin(s) | The GSE fibres arise from the abducens nucleus near the midline of pontine tegmentum.
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The Course
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Functional Components |
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Distribution |
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Probable cause and sites of injury |
Pontine vascular lesions (see middle alternating hemiplegia) Aneurysms of the basilar artery and its branches closely associated with the nerve Meningeal tumors Cavernous venous sinus thrombosis Fracture of base of the skull Aneurysms of the cavernous portion of the internal carotid artery Increased intra-cranial pressure
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Ophthalmoplegias | |
Paralysis or weakening of extra-ocular muscles is called ophthalmoplegia. Ophthalmoplegias are caused by the damage of the nerves that supply the muscles. They are classified according to which nerve is affected. |
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1) Oculomotor paralysis or paresis occurs following damage to the oculomotor nerve. The following features characterize it: External strabismus . The affected eye is turned down and out, owing to the unopposed action of the lateral rectus and superior oblique muscles. Ptosis , drooping of the upper eyelid, occurs because of paralysis of the levator palpebrae superioris muscle. Dilated pupil (mydriasis) with loss of the pupillary light reflex occurs due to interruption of the parasympathetic innervation of the pupillary constrictors and unopposed action of the sympathetic innervation of the pupillary dilators. Loss of accommodation reflex , due to interruption of all the necessary efferent nerves. |
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2) Trochlear nerve paralysis or paresis occurs following damage to the trochlear nerve. There are two main features, related to each other. External strabismus , with the eye rotating up and out, is due to paralysis of the superior oblique muscle, and unopposed action of the inferior oblique muscle. Usually the patient compensates by tilting the head (the chin points away from the side of the affected eye) to avoid Diplopia (double vision). On examination, the patient is unable to move the affected eye downward and outward. |
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3) Abducens nerve paralysis or paresis , occurs following damage to the abducens nerve and affects only the lateral rectus muscle. The major defect is internal strabismus, with the eye tending to deviate toward the nose because of the unopposed action of the medial rectus. The patient is unable to fully abduct the affected eye, and may tend to rotate the head towards the affected side to avoid diplopia. Some limited lateral movement of the eye is noted, because both the superior and inferior oblique muscles have a minor abductive component | |
Central Ophthalmoplegias
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