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June 1998

Managing Oculomotor Nerve Palsy

Arch Ophthalmol. 1998;116(6):798. doi:10.1001/archopht.116.6.798

THE MANAGEMENT of neurologically isolated, nontraumatic oculomotor nerve palsy is a challenge in the wise deployment of expensive and potentially harmful diagnostic tools.

Most cases are caused by ischemia of the nerve and do not require any diagnostic tests.15 Others are caused by inflammatory or neoplastic meningitis that can be diagnosed with a combination of magnetic resonance imaging and lumbar puncture. But some patients harbor a cerebral aneurysm that could kill them within days and for which timely treatment is curative. In the past, the diagnosis of aneurysm has depended entirely on catheter cerebral angiography, a test that maims or kills in about 1% to 2% of cases, and perhaps more among the elderly and those with ample arteriosclerotic risk factors.6

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