Ophthalmology · UKMLA & AKT
Diabetic cranial nerve palsies
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Diabetes causes microvascular ischaemia of the vasa nervorum → focal axonal injury in CN III, IV, or VI
- Pupil-sparing CN III palsy = ischaemic/diabetic cause - damage is in the nerve core, sparing superficial parasympathetic fibres
- Pupil-involved CN III palsy = compressive lesion (e.g. posterior communicating artery aneurysm) - external compression affects outermost parasympathetic fibres first
Pupil involvement in CN III palsy = posterior communicating artery aneurysm until proven otherwise - neurosurgical emergency requiring urgent MRI/MRA.
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