elitoki
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A 23 y/o male is found at the scene of a MVA with bilateral lowe extremity fracture. You also note extensive abd. bruising and scalp lacerations. At the scene, the pte's BP is 80/60, HR 120,. He is given 2 liter of IV fluids wide open. On way to the Hospital he becomes progressively drowsy and he develops progressive weakness on the right side of his body. This pt is also likely to show deficit in the functioning of which of the following nerve?
A VI craneal nerve (CN)
B. III CN
C. IX CN
D. V CN
E XI CN.
Could you tell me why and how you choose the answer. Thanks.
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| sprint123
Forum Guru
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mmmm....Good question!I am NOT too sure..The only thing I could think of
progressive weakness in a MVA case should be either direct trauma or hypotension. In this case, I would pick up the latter one.
Having said that, to choose the cranial nerve, I would pick CN III since it is the most commonly affected nerve due to hypotension or poor vascular supply similar to Diabetic neuropathy.
Any other inputs?
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| Ivonne
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I am not sure neither but
CN III is seen also with transtentorial herniation(tumor, subdural or epidural hematoma) and hypoperfusion conditions (thanks sprint for info) I would pick this one (B)
CN IV( not an alternative here): Because of its course around the midbrain, is particularly susceptible to head trauma.
CN VI: The most common isolated palsy due to its long peripheral course (this one was the first choice that came to my mind)
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| elitoki
Forum Guru
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You are Good !
Yes, answer is B. III CN.
Thanks 
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| RitaM
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Oculomotor because it has the longest intra cranial path.
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| genbot
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The answer is CN III.
This so because this patient has a probable intracranial bleed considering his mental status and hemiparesis. An intracranial bleed with an altered mental status usually means raised intracranial pressure and the first crranial to be affected by raised ICP is CN III ( of course the long course of the nerve contributes to that )
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| Ivonne
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Just wanted to add up the two most common surgical condition leading to oculomotor palsy are:
1.-Uncal herniation
2.-Aneurysm of the posterior communicating artery
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| drshvetasm
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B
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