Causes of oculomotor nerve palsy (reprinted from Lueck C10 with permission)
| Common | Uncommon | Rare | |
|---|---|---|---|
| Localisation by anatomical site | |||
| Fascicular | Head trauma Brainstem infarction Multiple sclerosis | Brainstem tumour Brainstem haemorrhage Syphilis Poliomyelitis Encephalitis | |
| Subarachnoid | Head trauma Aneurysm (posterior communicating artery) Tentorial herniation | Neurosurgical complication Aneurysm (basilar artery, superior cerebellar artery) Subarachnoid haemorrhage Meningitis (infective, inflammatory or neoplastic) | Arteriovenous malformation Ectatic basilar or posterior communicating artery Oculomotor nerve tumour Post lumbar puncture/myelography Hypertrophic pachymeningitis Superficial siderosis Idiopathic intracranial hypertension |
| Tumour | Cerebral venous sinus thrombosis | ||
| Cavernous sinus/superior orbital fissure | Head trauma Tumour, lymphoma | Carotico-cavernous fistula Internal carotid artery aneurysm, occlusion or dissection Cavernous sinus thrombosis Tolosa–Hunt syndrome Wegener's granulomatosis Herpes zoster | Pituitary apoplexy |
| Orbit | Head trauma | Tumour, lymphoma | Infections (eg, mucor mycosis) Retrobulbar anaesthesia Paget's disease of skull |
| Localisation uncertain | |||
| Congenital | ‘Congenital oculomotor nerve palsy’ | Aplasia Congenital fibrosis of the extraocular muscles | |
| Vascular | Nerve infarction (diabetes mellitus, hypertension, etc) | Nerve infarction (giant cell arteritis, vasculitis) | Carotid artery stenosis Protein S deficiency Hyperviscosity syndrome Cocaine, sildenafil |
| Inflammatory/infective | Sarcoidosis Post-viral Sinusitis | Sjögren's syndrome, Systemic lupus erythematosus Ophthalmoplegic migraine | |
| Metabolic/toxic | Wernicke's encephalopathy Drug/substance toxicity | ||
| Miscellaneous | Idiopathic | Dental anaesthesia | |