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Year : 2022  |  Volume : 8  |  Issue : 4  |  Page : 188-191

Spontaneous chronic subdural hematoma as the cause of oculomotor cranial nerve palsy: A narrative review

1 Department of Ophthalmology, “Santa Maria degli Angeli” Hospital, ASFO, Pordenone (PN), Italy
2 Department of Ophthalmology, Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy
3 Department of Ophthalmology, “De Gironcoli” Hospital, AULSS2 Marca Trevigiana, Conegliano (TV), Italy
4 Emergency Neurology and Stroke Unit, Santo Spirito Hospital, ASL Pescara, Pescara, Italy
5 Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston; Department of Ophthalmology, University of Texas Medical Branch, Galveston; University of Texas MD Anderson Cancer Center, Houston; Texas A and M College of Medicine, Bryan, TX; Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA

Correspondence Address:
Francesco Pellegrini
Department of Ophthalmology, "Santa Maria degli Angeli" Hospital, ASFO, Pordenone (PN)
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bc.bc_42_22

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Acute complete third nerve palsy with pupillary involvement is usually caused by a posterior communicating artery aneurysm (i.e. “the rule of the pupil”). The pupillary fibers run peripherally in the third nerve and are thus susceptible to the external compression. Headache is usually present, and urgent diagnosis and treatment are warranted. Rarely, however, neuroimaging shows other causes of third nerve palsy. In this study, we perform a literature review of spontaneous chronic subdural hematoma that, although rarely, may cause an acute pupil-involving third nerve palsy as a false localizing sign. We review the localizing, nonlocalizing, and false localizing nature of ocular motor cranial nerve palsy in this setting.

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