J Clin Neurol.  2019 Apr;15(2):221-227. 10.3988/jcn.2019.15.2.221.

Acquired Ocular Motor Nerve Palsy in Neurology Clinics: A Prospective Multicenter Study

• Choi KD
• Choi SY
• Kim JS
• Choi JH
• Yang TH
• Oh SY
• Kim SH
• Lee HS
• Lee SH
• Jeong SH
• Kim HJ
• Choi JY

• KMID: 2467736
• DOI: http://doi.org/10.3988/jcn.2019.15.2.221

Abstract

BACKGROUND AND PURPOSE
This study aimed to determine the patterns and etiologies of acquired ocular motor nerve palsy (OMNP) diagnosed in neurology clinics. We also investigated the clinical features that may predict the causes other than microvascular ischemia in isolated OMNP.
METHODS
We performed a prospective multicenter study that had recruited 298 patients with acquired OMNP from the neurology clinics of referral-based 9 university hospitals in Korea. We finally selected 235 patients with isolated OMNP and divided them into older (age ≥50 years, n=188) and younger (age <50 years, n=47) groups. We investigated the underlying etiologies of acquired OMNP. We also estimated the frequency of microvascular ischemia and other causes in isolated OMNP, and sought to determine the clinical features that can predict the causes other than microvascular ischemia.
RESULTS
Abducens nerve palsy was the most common (40%) of the acquired OMNPs, followed by oculomotor nerve palsy (27%), trochlear nerve palsy (23%), and multiple OMNPs (10%). The etiologies included microvascular ischemia (47%), inflammatory (21%), stroke (5%), trauma (5%), neoplasm (3%), and others (2%), with the cause not being determined in 13% of the patients. Microvascular ischemia was the most common cause (83%) in patients aged ≥50 years with isolated OMNP, followed by inflammation (6%), stroke (6%), neoplasm (3%), and aneurysm (1%). Microvascular ischemia was more common in the older than the younger group (83% vs. 49%, p<0.001). The intensity of headache was the only risk factor for causes other than microvascular ischemia in isolated OMNP.
CONCLUSIONS
Vascular and inflammatory disorders are the most common causes of acquired OMNP diagnosed in neurology clinics. Microvascular ischemia was the predominant cause of isolated OMNP. Severe headache indicates causes other than microvascular ischemia in isolated OMNP.

Keyword

acquired ocular motor nerve palsy; isolated ocular motor nerve palsy; diplopia; microvascular ischemia

MeSH Terms

Abducens Nerve Diseases
Aneurysm
Diplopia
Headache
Hospitals, University
Humans
Inflammation
Ischemia
Korea
Neurology*
Oculomotor Nerve Diseases
Paralysis*
Prospective Studies*
Risk Factors
Stroke
Trochlear Nerve Diseases

Figure

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  Fig. 1 Study flow diagram. Initially, 412 patients with acquired binocular diplopia were recruited, and 298 with acquired OMNP were selected for this study after excluding those with nuclear or supranuclear palsy, neuromuscular junction disorders, other causes, extraocular muscle disorders, and incomplete data. Among 298 patients with acquired OMNP, we further selected 235 with isolated OMNP after excluding patients with a history of preceding head trauma, multiple OMNPs, or other neurological symptoms and signs. We divided the patients with isolated OMNP into two groups according to their age: <50 years and ≥50 years. The outcome analysis was applied to 180 patients with isolated OMNP. NMJ: neuromuscular junction, OMNP: ocular motor nerve palsy.

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