J Korean Ophthalmol Soc.  2014 Apr;55(4):596-601.

Associated Injuries and Prognosis in Traumatic Isolated 3rd, 4th, and 6th Cranial Nerve Palsies

• Jeong JS
• Kim DH

Abstract

PURPOSE
To analyze the relationship between prognosis and the severity of associated injuries in traumatic isolated 3rd, 4th and 6th cranial nerve palsies.
METHODS
The records of 39 patients (39 eyes) who were diagnosed with isolated 3rd, 4th or 6th cranial nerve palsy following trauma were reviewed retrospectively to analyze the etiology of trauma, the degree of associated injuries, the degree of paralysis, and the prognosis.
RESULTS
The 4th cranial nerve was affected most frequently (19 patients, 48.7%), followed by the 6th nerve (12 patients, 30.8%) and the 3rd nerve (8 patients, 20.5%). Traffic accidents were the most frequent etiology of traumatic cranial nerve palsies. Loss of consciousness, intracranial hemorrhage, craniofacial fracture, c-spine injury, and optic nerve injury were among the most common accompanying conditions. The 3rd cranial nerve was the most severely paralyzed and showed the highest number of associated injuries. The recovery rate of the all cranial nerve palsies was 46.2%. By nerve, the 3rd cranial nerve palsy showed the lowest recovery rate of 25%, followed by the 4th nerve at 47.4%, and the 6th nerve at 58.3%.
CONCLUSIONS
The prognosis was worse in patients with intracranial hemorrhage, compared with those without intracranial hemorrhage. There was a higher average number of associated injuries and the degree of paralysis was more severe in 3rd nerve palsies.

Keyword

Cranial nerve palsy; Intracranial hemorrhage; Trauma

MeSH Terms

Accidents, Traffic
Cranial Nerve Diseases*
Cranial Nerves*
Humans
Intracranial Hemorrhages
Optic Nerve Injuries
Paralysis
Prognosis*
Retrospective Studies
Unconsciousness

Reference

References

1. Rucker CW. Paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol. 1958; 46:787–94.

2. Rucker CW. The causes of paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol. 1966; 61:1293–8.

3. 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.

4. Kim SS, Jin KH, Kim SM. Neuro-ophthalmologic evaluation of the third, fourth, and sixth cranial nerve paralysis. J Korean Ophthalmol Soc. 1991; 32:283–8.

5. Han ER, Lim KH. Clinical features of the sixth cranial nerve palsy. J Korean Ophthalmol Soc. 2008; 49:1323–9.

6. Lee DW. Neuro-ophthalmic manifestations of head trauma and predictive factors. J Korean Ophthalmol Soc. 2005; 46:422–8.

7. Sabates NR, Gonce MA, Farris BK. Neuro-ophthalmological findings in closed head trauma. J Clin Neuroophthalmol. 1991; 11:273–7.

8. Lepore FE. Disorder of ocular motility following head trauma. Arch Neurol. 1995; 52:924–6.

9. Keane JR, Baloh RW. Posttraumatic cranial neuropathies. Neurol Clin. 1992; 10:849–67.

10. Keane JR. Neurologic eye signs following motorcycle accidents. Arch Neurol. 1989; 46:761–2.

11. Kim HS, Lee JB, Han SH. Nontraumatic acquired paralytic strabismus. J Korean Ophthalmol Soc. 1994; 35:1127–31.

12. Park UC, Kim SJ, Yu YS. Clinical features and natural history of the acquired third, fourth, and sixth cranial nerve palsy. J Korean Ophthalmol Soc. 2005; 46:1555–62.

13. Shin H, Park SE. A clinical study of acquired paralytic strabismus in a secondary hospital. J Korean Ophthalmol Soc. 2007; 48:311–4.

14. Lee JS, Lee H, Shin H, Lee J. Significant intraocular sequelae in orbital blunt trauma and their association with blowout fracture. J Korean Ophthalmol Soc. 2012; 53:613–7.

15. Lepore FE. Disorder of ocular motility following head trauma. Arch Neurol. 1995; 52:924–6.

16. Dhaliwal A, West AL, Trobe JD, Musch DC. Third, fourth, and sixth cranial nerve palsies following closed head injury. J Neuroophthalmol. 2006; 26:4–10.

17. Park UC, Kim SJ, Hwang JM, Yu YS. Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy. Eye (Lond). 2008; 22:691–6.

18. Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery. 1982; 11:344–51.

19. Rimel RW, Giordani B, Barth JT, et al. Disability caused by minor head injury. Neurosurgery. 1981; 9:221–8.

20. Zettas JP, Zettas P, Thanasophon B. Injury patterns in motorcycle accidents. J Trauma. 1979; 19:833–6.

21. Elston JS. Traumatic third nerve palsy. Br J Ophthalmol. 1984; 68:538–43.

22. Memon MY, Paine KW. Direct injury of the oculomotor nerve in craniocerebral trauma. J Neurosurg. 1971; 35:461–4.

23. 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.

24. Holmes JM, Beck RW, Kip KE, et al. Predictors of nonrecovery in acute traumatic sixth nerve palsy and paresis. Ophthalmology. 2001; 108:1457–60.