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March 1975

Third Nerve Palsy-Reply

Author Affiliations

Department of Radiology Clinic for Nervous and Mental Diseases University of Milan Milan, Italy

Arch Neurol. 1975;32(3):208. doi:10.1001/archneur.1975.00490450088016

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To the Editor.—  The case reported by Dr. Sacks and Dr. Lindenberg is proof that pressure from enlarged arteries may cause atrophy of the oculomotor nerve. However, it is unlikely that this is the only mechanism of dysfunction in such cases; one has to explain the recurrent nature of the third nerve palsy in the reported cases. We recently observed a third patient with three transient episodes during the past year; he was neither hypertensive nor diabetic, and his angiographic picture was similar to the one already reported. In all three cases, the posterior cerebral artery arose from the internal carotid and was elongated and tortuous, but only minimally or not at all ectatic.More should be known about the anatomy of the small vasa nervorum to the third nerve; during micro-surgery on the vessels of the base of the brain, small feeding vessels are seen that could easily

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