Microvascular Cranial Nerve Palsy

Microvascular cranial nerve palsy can be caused by microvascular diseases

Microvascular cranial nerve palsy can happen as a result of microvascular diseases such as diabetes or heart disease. Common in people suffering from high blood pressure and diabetes, the condition causes double vision. Microvascular cranial nerve palsy also affects a high number of elderly people. Also known as diabetic palsy, it’s mostly associated with migraines among the younger set. In younger people, the problem of double vision is resolved on its own with age and only in rare cases, the patient may require treatment and surgery.

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Movement of Eye and the Role of Cranial Nerves

The eye moves with the help of six extra-ocular muscles, and four of these are in the front of eye, whereas, two are attached behind the four muscles. These two muscles are responsible for the up-and-down movement and twisting movement of the eye. The muscles function when they receive signals from the cranial nerves, which start from the brain stem, entering the eye socket through the bone fissure behind the eye. When the blood flow to the nerve is blocked, the eye may fail to move, resulting in vertical double vision. Sometimes, this type of double vision can be removed by titling the head. Any of the abducens nerve (cranial nerve 6), trochlear nerve (cranial nerve 4) or oculomotor (cranial nerve 3) may be responsible for double vision and poor eye movement.

Diagnosis

The diagnosis of microvascular cranial nerve palsy requires neurological examination and imaging. The blood pressure and sugar level of the patient is examined and CT scan or MRI is performed to arrive at a final decision. There is no treatment for the condition but the patient may be given anti inflammatory drugs to reduce the pain and other medication to control blood pressure and blood sugar. In some cases, the patient is treated with patching eyes or placing prisms, and sometimes, the surgery of eye muscles is done to retain normal functioning.

Surgery of Cranial Nerves

Surgery is recommended to reduce the pain or to relieve pressure on the nerve. Cranial nerve surgeries are done through a small skull opening and blood vessel compression is done by compressing the nerves. The surgery of sixth nerve palsy is done to reduce misalignment and to stabilize the midline. Depending on the degree by which the nerve has been affected, the surgery will be performed accordingly. The fourth nerve palsy may not be detected until adulthood and surgery is required in this condition to reduce vertical deviation. Sometimes, the surgery for fourth nerve palsy is done post-cataract surgery. In the case of fourth cranial nerve palsy, the muscles attached to the globe are realigned to improve vision. If the third cranial nerve is affected, the patient may experience double vision due to the poor functioning of muscles which helps in the up-and-down motion. The eyelid may drop or the motion turns away from nose. For dropping eyelids, the surgery of third cranial nerve is done and surgery methodologies used for correction are levator resection, Muller’s muscle resection, and frontalis sling operation.

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