Diseases of the nervous system : a text-book of neurology and psychiatry . salso a diplopia. DISEASES OF THE OCULOMOTOR NERVES 203 Sixth nerve palsy more usually results from basilar disease, fractureof base, meningitis (syphilitic and other types), tumors not only of thebase but also of the brain substance itself. Nuclear involvement isseen in encephalitis, poliomyelitis, toxemias, etc. External rectuspalsy as a result of a myositis is not unknown. Central Motor Neurones.—Isolated eye palsies are due to nuclearor to peripheral involvement of the third, fourth and sixth dis
Diseases of the nervous system : a text-book of neurology and psychiatry . salso a diplopia. DISEASES OF THE OCULOMOTOR NERVES 203 Sixth nerve palsy more usually results from basilar disease, fractureof base, meningitis (syphilitic and other types), tumors not only of thebase but also of the brain substance itself. Nuclear involvement isseen in encephalitis, poliomyelitis, toxemias, etc. External rectuspalsy as a result of a myositis is not unknown. Central Motor Neurones.—Isolated eye palsies are due to nuclearor to peripheral involvement of the third, fourth and sixth disease, involving the oculomotor paths, does not resultin the loss of function of a single eye, much less of a single eye lesions between the oculomotor cortex and the nuclei in themidbrain cause complicated disorders of the associated movements ofthe eyes. The most frequent of these are: (a) conjugate deviation,(6) lateral associated palsy, (c) vertical associated palsy, (d) loss of con-vergence, (e) central nystagmus, (/) irregular types. (See Plate VIII.). Fig. 94.—Paralysis of upward movement of the eyes, showing the excessive wrinklingof the forehead in the attempt to look up. Skew deviation. (Holmes.) (a) Conjugate Deviation.—Here both of the eyes are directed tothe side of the lesion, and cannot be voluntarily moved in an oppositedirection. Yet, if the eyes are fixed upon an object and the headis turned away from the lesion, the eyes will turn in the directionwhich voluntarily is impossible. This is termed conjugate deviationof the eyes and head. The eye axes may not be truly parallel,but may diverge slightly. In acute apoplexies this symptom isoccasionally seen,—i. e., forced deviation of the head to the side ofthe lesion. Lesions of the inferior parietal, angular gyrus, and possibly the foot EXPLANATION OF PLATE VIII. The Oculorotary Paths and in Particular the Innervation of theMuscles which Turn the Head. Ahbreviaiions.—BrQa, arms of anterior coip
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