Acute ophthalmoplegia (ophthalmoparesis)

A. Acute unilateral ophthalmoplegia (ophthalmoparesis)

The main causes of acute ophthalmoplegia (ophthalmoparesis):

1. Aneurysm or vascular anomaly (hemorrhage or nerve compression) at the junction of the posterior communicating artery and internal carotid artery (oculomotor nerve) or the anterior inferior cerebellar and basilar arteries (abducens nerve).
2. Minor hemorrhages in the brain stem area (embolism, leukemia, coagulopathy).
3. Ophthalmoplegic migraine (transient damage to the oculomotor nerve in 85% of cases and the abducens or trochlear nerve in 15%).
4. Cavernous sinus thrombosis (the source of sinus thrombosis is almost always an infectious process in the mouth, nose or face.
5. Inferior petrosal sinus thrombosis (originates from middle ear infection; abducens, facial nerves, and trigeminal ganglion are affected).
6. Cavernous sinus fistula (traumatic origin).
7. Brain tumor (brainstem glioma, craniopharyngioma, pituitary adenoma, nasopharyngeal carcinoma, lymphoma, pineal gland tumor).
8. Idiopathic cranial polyneuropathy (in case of frequently observed unilateral involvement).
9. Myasthenia gravis.
10. Orbital tumor (dermoid cyst, hemangioma, metastatic neuroblastoma, optic glioma, rhabdomyosarcoma) and inflammatory processes in the orbit (orbital pseudotumor, sarcoidosis).
11. Trauma (orbital bone fracture with muscle damage)
12. Intracranial hypertension (infringement of the uncus of the temporal lobe in the opening of the tentorium cerebellum; pseudotumor cerebri).
13. Demyelinating processes affecting, for example, the roots of the glomerular nerves (III, IV and VI nerves).
14. Tolosa-Hunt syndrome.

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B. Acute bilateral ophthalmoplegia (ophthalmoparesis)

Most of the causes mentioned above that cause acute unilateral ophthalmoplegia can also result in acute bilateral ophthalmoplegia.

Main reasons:

1. Botulism, HIV infection (encephalopathy).
2. Basilar meningitis (including carcinomatous).
3. Intoxications (anticonvulsants, tricyclic antidepressants, other psychotropic drugs at toxic concentrations in the blood serum).
4. Stem forms of encephalitis (echoviruses, coxsackieviruses, adenoviruses).
5. Stroke in the brainstem region.
6. Diphtheria.
7. Cavernous sinus thrombosis.
8. Carotid-cavernous fistula.
9. Myasthenia gravis.
10. Thyrotoxicosis.
11. Midbrain hematoma.
12. Brainstem entrapment syndrome (transtentorial herniation).
13. Pituitary apoplexy.
14. Miller Fisher syndrome.
15. Leigh disease (subacute necrotizing encephalomyelitis).
16. Multiple sclerosis.
17. Neuroleptic malignant syndrome (rare).
18. Orbital pseudotumor.
19. Paraneoplastic encephalomyelitis.
20. Polyradiculopathy involving cranial nerves.
21. Traumatic brain injury.
22. Wernicke's encephalopathy.
23. Psychogenic form (pseudo-ophthalmoplegia).

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