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CRANIAL NERVES III, IV, VI CRANIAL NERVE III • • • • • • • • • NUCLEUS IN FLOOR OF CEREBRAL AQUEDUCT AT LEVEL OF SUPERIOR COLLICULUS SOMATIC EFFERENT NUCLEUS SUPPLIES EXTRAOCULAR MUSCLES EDINGER WESTPHAL NUCLEUS SUPPLIES PARASYMPATHETIC FIBRES FIBRES EMERGE FROM MIDBRAIN MEDIAL TO CEREBRAL PEDUNCLE PASSES FORWARD BETWEEN SUPERIOR CEREBELLAR AND POSTERIOR CEREBRAL ARTERIES PIERCES THE DURA MATER TO RUN FORWARD IN THE LATERAL WALL OF THE CAVERNOUS SINUS TO THE SUPERIOR ORBITAL FISSURE DIVIDES INTO SUPERIOR AND INFERIOR BRANCHES WHICH ENTER THE ORBIT THROUGH TENDINOUS RING FROM WHICH THE RECTI ARISE INFERIOR BRANCH SUPPLIES MEDIAL AND INFERIOR RECTUS AND INFERIOR OBLIQUE SUPERIOR BRANCH SUPPLIES SUPERIOR RECTUS MUSCLE AND LEVATOR PALPEBRAE SUPERIORIS CILIARY GANGLION • • LIES NEAR APEX OF ORBIT LATERAL TO OPTIC NERVE PREGANGLIONIC PARASYMPATHETIC FIBRES FROM EW NUCLEUS SYNAPSE AND EFFERENT FIBRES PASS TO CILIARY MUSCLE AND IRIS MUSCLE BY ABOUT 10 SHORT CIIARY NERVES • PTOSIS CRANIAL NERVE III DIVISION • • • • DIVERGENT SQUINT DILATATION OF PUPIL LOSS OF ACCOMODATION CONVERGENCE AND LIGHT REFLEXES DOUBLE VISION CRANIAL NERVE IV • • • • • • • • • • NUCLEUS LIES AT LEVEL OF INFERIOR COLLICULUS FIBRES PASS DORSALLY AROUND THE CEREBRAL AQUEDUCT AND DECUSSATE IN THE SUPERIOR MEDULLARY VELUM EMERGES ON DORSUM OF MIDBRAIN AND WINDS ROUND THE CEREBRAL PEDUNCLE PASSES FORWARD BETWEEN THE SUPERIOR CEREBELLAR AND POSTERIOR CEREBRAL ARTERIES TO PIERCE THE DURA RUNS FORWARD IN THE LATERAL WALL OF CAVERNOUS SINUS BETWEEN NIII AND OPHTHALMIC NERVES ENTERS ORBIT THROUGH SUPERIOR ORBITAL FISSURE LATERAL TO TENDINOUS RING SUPERIOR OBLIQUE PARALYSIS WITH DIPLOPIA ON DOWNGAZE PARTICULARLY IN READING AND WALKING STAIRS NUCLEUS IN UPPER PONS FIBRES PASS THROUGH PONTINE TEGMENTUM TO EMERGE AT BASE OF BRAIN AT JUNCTION BETWEEN PONS AND MEDULLA PASSES FORWARD INTO CAVERNOUS SINUS AND LIES LATERAL TO INTERNAL CAROTID • ARTERY AND MEDIAL TO III, IV AND Vth NERVES PASSES THROUGH TENDINOUS RING CRANIAL NERVE IV • • LATERAL RECTUS PARALYSIS RESULTS IN CONVERGENT SQUINT AND DIPLOPIA SYMPATHETIC SYSTEM • • • RADIAL PUPILLODILATOR MUSCLE ASCENDING CERVICAL SYMPATHETIC SYSTEM SPINAL SEGMENTS T1 TO T3 MULLER’S MUSCLE MOVEMENTS OF THE EYE • • • • • • ABDUCTION ADDUCTION ELEVATION DEPRESSION INTORSION EXTORSION CENTRAL CONTROL OF EYE MOVEMENTS: HORIZONTAL GAZE • • • • • CONTRALATERAL FRONTAL EYE FIELDS CONTRALATERAL PARAMEDIAN PONTINE RETICULAR FORMATION IPSILATERAL ABDUCENS NUCLEUS MEDIAL LONGITUDINAL FASCICULUS CONTRALATERAL OCULOMOTOR NUCLEUS OF THE MIDBRAIN CENTRAL CONTROL OF EYE MOVEMENTS: VERTICAL GAZE ARGYL ROBERTSON PUPIL • • • • LOSS OF LIGHT REFLEX ACCOMODATION REFLEX PRESENT TERTIARY SYPHILIS AUTONOMIC NEUROPATHY OF DIABETES MELLITUS HORNER’S SYNDROME • • • • LESION OF SYMPATHETIC SYSTEM PTOSIS MIOSIS ANHIDROSIS THANKS
