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August 1993

The Origin of Pain in 'Ischemic-Diabetic' Third-Nerve Palsy

Author Affiliations

Institute of Normal Veterinary Anatomy University of Bologna Via Belmeloro 12 40100 Bologna Italy
Department of Neurology University of Bologna Via U Foscolo 7 40123 Bologna Italy
Institute of Human Physiology Catholic University Largo F Vito 1 00168 Rome Italy

Arch Neurol. 1993;50(8):795. doi:10.1001/archneur.1993.00540080008003

To the Editor.  —Textbooks of neurology and neuro-ophthalmology usually describe the so-called ischemic-diabetic acute third-nerve palsy as accompanied by severe pain around the eye and forehead, but no explanation for the origin of such pain is ever given. Though it is surprising that ischemia of a motor nerve provokes pain, recent articles contain findings that could throw some light on the presence of such pain.In the monkey and some other mammals,1,2 the oculomotor nerve has been shown to contain sensory fibers that are the central processes of trigeminal ganglion cells located in the ophthalmic region of the ganglion. These primary trigeminal afferent fibers running in the oculomotor nerve terminate mostly in the subnucleus gelatinosus of the nucleus caudalis trigemini, similarly to the thermal and nociceptive classical primary trigeminal afferents entering the brain stem through the trigeminal root. Moreover, it has been shown in the sheep that trigeminal neurons

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