Manual
CN III, IV and VI palsies
Neuro-Ophthalmology
CN III, IV and VI palsies
Which ones need emergent imaging?
| Palsy | Findings | Key causes |
|---|---|---|
| CN III | Down & out, ptosis, ± dilated pupil | PCOM aneurysm (pupil-involving), microvascular (pupil-sparing) |
| CN IV | Hypertropia worse on contralateral gaze & ipsilateral tilt | Trauma, congenital (decompensated), microvascular |
| CN VI | Esotropia worse in ipsilateral gaze | Microvascular, raised ICP (false localising), Gradenigo, tumour |
Any pupil-involving or partial CN III palsy, age < 50, multiple cranial neuropathies or other neuro signs → emergent neuroimaging. Microvascular palsies should improve within 3 months.
Educational summary — follow local protocols and current guidelines.