眶上裂與眶尖綜合征，顱內動脈瘤，顱內腫瘤，其它如結核、霉菌、梅毒與化膿性炎癥引起的顱底腦膜炎等。由于病細菌不同，其發病機理亦各不相同，如腫瘤的直接壓迫所致，原發性炎癥時，動眼、滑車與外展神經纖維呈脫髓鞘改變等。1、動眼神經麻痹表現為上瞼下垂，眼球外斜，向上外、上內、下內、同側方向運動障礙，瞳孔散大，對光反應及調節反應消失，頭向健側歪斜。*性癱瘓多為周圍性，而不*性多為核性。2、滑車神經麻痹表現為眼球不能向下外方向運動，伴有復視，下樓時復視明顯，致使下樓動作十分困難。頭呈特殊位，呈下頦向下頭面向健側的姿勢。3、外展神經麻痹表現為眼內斜視，不能外展，并有復視。（一）核性及束性麻痹細菌動眼神經核在中腦占據的范圍較大，故核性損害多引起不全麻痹，且多為兩側性，可見有神經梅毒，臘腸中毒及白喉等。束性損害多引起一側動眼神經麻痹，表現為同側瞳孔擴大，調節機能喪失及瞼下垂，眼球被外直肌及上斜肌拉向外側并稍向下方。1、腦干腫瘤:特征的臨床表現為出現交叉性麻痹，即病變節段同側的核及核下性顱神經損害及節段下對側的錐體束征。顱神經癥狀細菌病變節段水平和范圍不同而異。如中腦病變多表現為病變側動眼神經麻痹，橋腦病變可表現為病變側眼球外展及面神經麻痹，同側面部感覺障礙以及聽覺障礙。延髓病變可出現病變側舌肌麻痹、咽喉麻痹、舌后1/3味覺消失等。腦干誘發電位、CT、MRI可明確診斷。2、腦干損傷:多有明確的外傷史,傷后長時間的昏迷,且有眼球運動障礙等,診斷不難。3、顱底骨折:顱腦外傷后可損傷頸內動脈，產生頸內動脈—海綿竇瘺出現眼球運動受限和視力減退，同時可有頭部或眶部連續性雜音，搏動性眼球突出。1、顱底動脈瘤:動眼神經麻痹單獨出現時，常見于顱底動脈瘤而罕見于其他腫瘤。本病多見于青壯年，多有慢性頭痛及蛛網膜下腔出血病史，亦可以單獨的動眼神經麻痹出現。腦血管造影多能明確診斷。
Orbital fissure and orbital apex syndrome, intracranial aneurysms, intracranial tumors, other such as tuberculosis, mold, syphilis and purulent inflammation caused by skull base meningitis. Due to the different bacteria, the pathogenesis is also different, such as direct compression of the tumor caused by primary inflammation, oculomotor, pulley and outreach nerve fibers were demyelinated changes. 1, oculomotor nerve paralysis manifested ptosis, eyeball oblique, upward, medial, inferior, ipsilateral dyskinesia, mydriasis, light response and regulatory response disappeared, head to the contralateral skew. Complete paralysis is mostly peripheral, but not complete and mostly nuclear. 2, the performance of the pulley nerve paralysis can not be the downward direction of the eye movement, with diplopia, apparent dip under the stairs, resulting in very difficult action down the stairs. Head was a special bit, was chin downward head facing the contralateral posture. 3, outreach nerve paralysis manifested as intraocular strabismus, can not be outreach, and diplopia. (A) of the nucleus and bundle paralysis bacteria oculomotor nerve nucleus in the brain to occupy a larger range, so more than the nuclear damage caused by incomplete paralysis, and mostly bilateral, showing neurosyphilis, dachshund poisoning and diphtheria. Beam damage caused by more oculomotor nerve paralysis on one side, manifested as ipsilateral pupil dilation, loss of regulatory function and ptosis, the eye was lateral and lateral oblique pull the lateral muscle and slightly downward. 1, brain stem tumors: the clinical manifestations of the characteristics of the emergence of cross-paralysis, ipsilateral lesion of the nucleus and subnuclear cranial nerve damage and contralateral cone pyramidal signs. Cranial neurological symptoms vary in the level and extent of bacterial disease. Such as midbrain lesions showed lesions lateral oculomotor nerve palsy, pons can be manifested as lesion side of the eyeball outreach and facial paralysis, ipsilateral facial sensory disturbances and hearing impairment. Bulbar lesion lesions of the lateral tongue can be paralysis, pharyngolaryngeal paralysis, the tongue after the disappearance of 1/3 taste. Brainstem evoked potential, CT, MRI can confirm the diagnosis. 2, brain stem injury: a clear history of trauma, after a long period of coma, and eye movement disorders, the diagnosis is not difficult. 3, skull fracture: after traumatic brain injury can damage the internal carotid artery, resulting in internal carotid artery - cavernous fistula appear limited eye movement and vision loss, at the same time there may be continuous head and orbital murmur, pulsatile eyeball prominent. 1, skull base aneurysm: oculomotor nerve paralysis alone, common in the skull base aneurysms and rare in other tumors. The disease more common in young adults, and more chronic headache and history of subarachnoid hemorrhage, can also be a separate oculomotor nerve paralysis. Cerebral angiography can definiy diagnose.

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