J Korean Ophthalmol Soc.  2014 May;55(5):740-745. 10.3341/jkos.2014.55.5.740.

Risk Factors and Prognosis of Isolated Ischemic 3rd, 4th, 6th Cranial Nerve Palsy

• Chun JW
• Kim DH

• KMID: 2218096
• DOI: http://doi.org/10.3341/jkos.2014.55.5.740

Abstract

PURPOSE
To investigate the clinical features and risk factors of ischemic third, fourth, sixth cranial nerve palsy.
METHODS
Retrospectively, we reviewed the medical records of 46 eyes of 46 patients who were diagnosed with ischemic third, fourth, sixth nerve palsy alone such as age of onset, risk factors, recovery rate and recovery time.
RESULTS
The mean age of onset was 64.9 years. Of the 46 patients, 15 patients (32.6%) in third cranial nerve palsy group, 15 patients (32.6%) in fourth cranial nerve palsy group, 16 patients (34.8%) in sixth cranial nerve palsy group. The risk factor of hypertension in 30 patients (65.2%) was the most common than other risk factors such as diabetes, hyperlipidemia, elevated blood hematocrit, ischemic heart disease, left ventricular hypertrophy, smoking. The mean number of risk factors was 2.3 +/- 0.5 in third cranial nerve palsy group, 1.6 +/- 1.1 in sixth cranial nerve palsy group, 1.4 +/- 1.1 in fourth cranial nerve palsy group. Of the 46 patients, 42 patients (91.3%) were recovered. There was no significant difference in recovery rate by cranial nerve palsy. Recovery time of intracranial abnormalities group (10.5 +/- 2.9 weeks) in brain imaging study was late as compared with that of no intracranial abnormalities group (7.5 +/- 5.1 weeks).
CONCLUSIONS
The overall recovery rate of isolated ischemic third, fourth, sixth cranial nerve was high. But if there are intracranial abnormalities in imaging study, it took a long time to recover. Also ischemic third cranial nerve palsy had multiple risk factors characteristically.

Keyword

Cranial nerve palsy; Ischemic; Recovery

MeSH Terms

Abducens Nerve
Abducens Nerve Diseases
Age of Onset
Cranial Nerve Diseases*
Hematocrit
Humans
Hyperlipidemias
Hypertension
Hypertrophy, Left Ventricular
Medical Records
Myocardial Ischemia
Neuroimaging
Oculomotor Nerve
Paralysis
Prognosis*
Retrospective Studies
Risk Factors*
Smoke
Smoking
Trochlear Nerve Diseases
Smoke

Figure

• 

  Figure 1. Distribution of patients with 3, 4, 6th cranial nerve palsy by combination of risk factor. HTN = hypertension; DM = diabetes mellitus; LVH = left ventricular hypertrophy.

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