Clinical Features and Natural History of the Acquired Third, Fourth, and Sixth Cranial Nerve Palsy

Park, Un Chul; Kim, Seong Joon; Yu, Young Suk

Abstract

PURPOSE
To analyze the clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy. METHODS: We reviewed the medical records of 89 patients who were diagnosed with acquired third, fourth, and sixth nerve palsy from January 2003 to March 2005. The natural course of the disease and the factors affecting recovery were analyzed for the 66 patients who had their first ocular examination within 3 months from onset and were followed up for at least 6 months. RESULTS: The average age of onset was 50.1 years. The sixth cranial nerve was affected most frequently (n=43, 48.3%). Vascular disease (n=27, 30.3%) was most common etiology of cranial nerve palsy, followed by an undetermined cause (n=19, 21.3%). Of the 66 patients who had their first ocular examination within 3 months from onset and were followed up for at least 6 months, 40 (60.6%) patients showed a decrease in the angle of deviation by more than 10 prism diopters, and of these, 32 (48.5%) patients made a complete recovery from pareses. The recovery rates for patients with vascular disease or undetermined etiology (p=0.001), milder initial eyeball deviation and ocular motor restriction (p<0.001) were higher. CONCLUSIONS: In the natural course of the disease, the recovery rate of acquired third, fourth, and sixth nerve palsy was 60.6%. The most favorable prognosis occurred with vascular disease, undetermined etiology, and less severe paralysis on onset.