Korean Journal of Ophthalmology

The Korean Ophthalmological Society (대한안과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Course and Prognostic Factors of Acquired Third, Fourth, and Sixth Cranial Nerve Palsy in Korean Patients

  • Kim, Kiyoung (Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Noh, Sung Rae (Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Kang, Min Seok (Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Jin, Kyung Hyun (Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine)
  • Received : 2017.04.23
  • Accepted : 2017.09.12
  • Published : 2018.06.05
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to evaluate the clinical course and prognostic factors of acquired third, fourth, and sixth cranial nerve (CN) palsy grouped according to etiology. Methods: This study involved a retrospective review of the medical records of 153 patients who were diagnosed with acquired paralytic strabismus from January 2004 to July 2015. Outcomes, recovery rates, and time to recovery were investigated according to the affected CN: CN3, CN4, and CN6 palsies. The patients were classified into four groups based on etiology: idiopathic, traumatic, neoplastic, and vascular. Results: The mean age of the patients was $59.8{\pm}14.5$ years and the mean follow-up period was 10.8 months. Out of the 153 patients, 63 (41.2%) had CN3 palsy, 35 (22.9%) had CN4 palsy, and 55 (35.9%) had CN6 palsy. The most common causes were vascular related (54.9%), followed by idiopathic (28.1%), trauma (8.5%), and neoplasm (5.88%). About 50% of the patients recovered within six months. Among the four etiologic groups, the idiopathic group showed the best prognosis because about 50% of the patients in this group recovered within three months. This was followed by the vascular, traumatic, and neoplastic groups. Cox proportional hazard analysis revealed a significant association between the baseline prism diopter and recovery rate. Conclusions: The prognosis and natural history of paralytic strabismus vary depending on its cause. The vascular group had the best recovery rate and shortest recovery time, whereas the neoplastic group required the longest time to recover.

Keywords

References

  1. de Camargo GB, Hida WT, Goldchmit M, et al. Paralytic strabismus: review of 24 years at "Santa Casa de Sao Paulo". Arq Bras Oftalmol 2007;70:585-7. https://doi.org/10.1590/S0004-27492007000400005
  2. Mwanza JC, Ngweme GB, Kayembe DL. Ocular motor nerve palsy: a clinical and etiological study. Indian J Ophthalmol 2006;54:173-5. https://doi.org/10.4103/0301-4738.27068
  3. Richards BW, Jones FR Jr, Younge BR. Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol 1992;113:489-96. https://doi.org/10.1016/S0002-9394(14)74718-X
  4. Patel SV, Holmes JM, Hodge DO, Burke JP. Diabetes and hypertension in isolated sixth nerve palsy: a population-based study. Ophthalmology 2005;112:760-3. https://doi.org/10.1016/j.ophtha.2004.11.057
  5. Sanders SK, Kawasaki A, Purvin VA. Long-term prognosis in patients with vasculopathic sixth nerve palsy. Am J Ophthalmol 2002;134:81-4. https://doi.org/10.1016/S0002-9394(02)01439-3
  6. Choung HK, Chang BL. Clinical features of ischemic ophthalmoplegia caused by diabetes mellitus or hypertension. J Korean Ophthalmol Soc 2002;43:131-5.
  7. Jacobson DM, McCanna TD, Layde PM. Risk factors for ischemic ocular motor nerve palsies. Arch Ophthalmol 1994;112:961-6. https://doi.org/10.1001/archopht.1994.01090190109029
  8. Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI: cause and prognosis in 1,000 cases. Arch Ophthalmol 1981;99:76-9. https://doi.org/10.1001/archopht.1981.03930010078006
  9. Patel SV, Mutyala S, Leske DA, et al. Incidence, associations, and evaluation of sixth nerve palsy using a population- based method. Ophthalmology 2004;111:369-75. https://doi.org/10.1016/j.ophtha.2003.05.024
  10. Ho TH, Lin HS, Lin MC, Sheu SJ. Acquired paralytic strabismus in Southern Taiwan. J Chin Med Assoc 2013;76:340-3. https://doi.org/10.1016/j.jcma.2013.03.003
  11. Tiffin PA, MacEwen CJ, Craig EA, Clayton G. Acquired palsy of the oculomotor, trochlear and abducens nerves. Eye (Lond) 1996;10(Pt 3):377-84. https://doi.org/10.1038/eye.1996.77
  12. Lee WY, Kim JH, Shin H. A clinical study of paralytic strabismus. J Korean Ophthalmol Soc 1993;34:549-54.
  13. Park UC, Kim SJ, Yu YS. Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy. J Korean Ophthalmol Soc 2005;46:1555-62.
  14. Hopf HC, Gutmann L. Diabetic 3rd nerve palsy: evidence for a mesencephalic lesion. Neurology 1990;40:1041-5. https://doi.org/10.1212/WNL.40.7.1041
  15. Coello AF, Canals AG, Gonzalez JM, Martin JJ. Cranial nerve injury after minor head trauma. J Neurosurg 2010;113:547-55. https://doi.org/10.3171/2010.6.JNS091620
  16. Shin H, Park SE. A clinical study of acquired paralytic strabismus in a secondary hospital. J Korean Ophthalmol Soc 2007;48:311-4.
  17. Park KH, Chang BL. The etiology and clinical feature of the third, fourth, and sixth cranial nerve palsy. J Korean Ophthalmol Soc 1997;38:1432-6.
  18. Asbury AK, Aldredge H, Hershberg R, Fisher CM. Oculomotor palsy in diabetes mellitus: a clinico-pathological study. Brain 1970;93:555-66. https://doi.org/10.1093/brain/93.3.555
  19. Hyun J, Kim SY. Clinical features and natural course of superior oblique palsy. J Korean Ophthalmol Soc 2013;54:627-31. https://doi.org/10.3341/jkos.2013.54.4.627

Cited by

  1. The incidence and etiology of sixth cranial nerve palsy in Koreans: A 10-year nationwide cohort study vol.9, pp.1, 2018, https://doi.org/10.1038/s41598-019-54975-5
  2. Post-Stroke Oculomotor Nerve Palsy Treated by Traditional Korean Medicine: Three Case Reports vol.40, pp.6, 2018, https://doi.org/10.22246/jikm.2019.40.6.1237
  3. 매선요법을 병행한 특발성 동안신경마비 한방치험 1례 vol.33, pp.3, 2018, https://doi.org/10.6114/jkood.2020.33.3.138
  4. Aetiology, clinical features and surgical outcomes of isolated medial rectus palsy vol.48, pp.9, 2018, https://doi.org/10.1111/ceo.13867
  5. The Incidence and Etiologies of Third Cranial Nerve Palsy in Koreans: A 10-year Nationwide Cohort Study vol.27, pp.6, 2018, https://doi.org/10.1080/09286586.2020.1773870
  6. A review of transposition techniques for treatment of complete abducens nerve palsy vol.33, pp.3, 2018, https://doi.org/10.4103/joco.joco_42_21
  7. Utilisation du Lancaster en recherche clinique vol.14, pp.2, 2018, https://doi.org/10.1016/j.rfo.2020.10.002