Table 13.3
Clinical rules to determine whether an oculomotor nerve palsy is due to a nuclear lesion (after Daroff 1970)

1. Conditions which cannot represent nuclear lesions:

 

unilateral external ophthalmoplegia (with or without pupil involvement) associated with normal contralateral superior rectus function

 

unilateral internal ophthalmoplegia

 

unilateral ptosis

 

isolated unilateral or bilateral medial rectus weakness

2. Conditions which may be nuclear:

 

bilateral total third nerve palsy

 

bilateral ptosis

 

bilateral internal ophthalmoplegia

 

isolated single muscle involvement (except levator and superior rectus)

3. Obligatory nuclear lesions:

 

unilateral third nerve palsy with contralateral superior rectus and bilateral partial ptosis

 

bilateral third nerve palsy (with or without internal ophthalmoplegia) associated with spared levator function

1. Conditions which cannot represent nuclear lesions:

 

unilateral external ophthalmoplegia (with or without pupil involvement) associated with normal contralateral superior rectus function

 

unilateral internal ophthalmoplegia

 

unilateral ptosis

 

isolated unilateral or bilateral medial rectus weakness

2. Conditions which may be nuclear:

 

bilateral total third nerve palsy

 

bilateral ptosis

 

bilateral internal ophthalmoplegia

 

isolated single muscle involvement (except levator and superior rectus)

3. Obligatory nuclear lesions:

 

unilateral third nerve palsy with contralateral superior rectus and bilateral partial ptosis

 

bilateral third nerve palsy (with or without internal ophthalmoplegia) associated with spared levator function

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