Pupil-Sparing Third Nerve Palsy — SCE Neurology MCQ
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Correct answer: A — Urgent neuroimaging or neurovascular assessment rather than assuming microvascular disease
The best answer is “Urgent neuroimaging or neurovascular assessment rather than assuming microvascular disease”. Pupil sparing does not safely prove a microvascular cause, particularly in a young patient with acute pain. Compressive and vascular causes require urgent imaging before reassurance. The alternatives “Diagnose microvascular palsy from pupil sparing alone, after specialist assessment”, “Treat as ocular myasthenia without imaging the painful palsy”, “Observe for spontaneous recovery before arranging assessment, within the relevant UK pathway”, “Use normal non-contrast CT to exclude every compressive cause” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.
Reference: NICE NG127 suspected neurological conditions recommendations: https://www.nice.org.uk/guidance/ng127/chapter/Recommendations-for-adults-aged-over-16