Neurology Main神经内科 111-1-课件.ppt

Neurology Main 111-120 Q 111A 59-year-old male presents to the ER with diplopia that started several hours ago. He has no other complaints. His past medical history is significant for long-standing diabetes with poor glycemic control, right knee osteoarthritis, and peptic ulcer disease. Physical examination reveals right-sided ptosis with the right eye looking down and out. Pupils are equal and reactive to Sight. This patients condition is most likely due to which of the following?A. Nerve compression B. Nerve ischemia C. Nerve Inflammation D. Lacunar stroke E. Muscle infiltration A 111Correct answer:BDiabetes mellitus causes a number of complications: with neuropathy being very common. Diabetics most commonly have (symmetric) peripheral neuropathy, mononeuropathy, and autonomic neuropathy. Mononeuropathies are divided into cranial and somatic - among cranial nerves,. CN III is affected the most often.In diabetes, oculomotor nerve (CN Ill) neuropathy is ischemic. Somatic and parasympathetic fibers of CN III have separate blood supplies. For this reason, diabetic CN III neuropathy affects only somatic fibers, leaving parasympathetic fibers intact Symptoms are ptosis and a down and out gaze. Accommodation and the pupils response to light remain intact. (Alternatively, if nerve compression causes CN III neuropathy, both somatic and parasympathetic fibers will be affected. Patients will have ptosis, a rfdown and ouf gaze, a fixed, dilated pupil, and no accommodation reflex.)CN III (oculomotor nerve) has the following functions:1.Its somatic component innervates the inferior, superior, and medial rectus, inferior oblique and levator palpebrae muscles. Ptosis occurs due to paralysis of the levator palpebrae; whereas, the unopposed action of the lateral rectus (CN VI) and superior oblique (CN IV) muscles lead to a down and out gaze.2.Parasympathetic fibers of CN III innervate the sphincter of the iris and the ciliary muscle. Paralysis of parasympathetic fibers causes a fix