Clinical characteristics and etiological analysis of the peripheral third nerve palsy

Abstract

Objective To summarize and analyze the etiology and clinical features of the third nervepalsy(TNP). Methods and Results The clinical data of patients with TNP diagnosed from January to October 2019 were retrospectively analyzed. A total of 32 patients with TNP were included. There were 17 cases (53.12%) of acute onset and 15 cases (46.88%) of subacute onset. Monocular involvement was found in 30 cases (93.75%) and binocular involvement in 2 cases (6.25%). There were 10 cases (31.25%) with headache, and 8 cases(25%)with pupil involvement. Theetiology wasdiagnosed as microcirculation disorder (16cases,50%), non⁃specific inflammation (11cases,34.38%), posterior communication aneurysm (2 cases, 6.25%), midbrain infarction (1 case, 3.13%), brain stem demystification (1 case, 3.13%) and eosinophilia (1 case, 3.13% ). Improvement of circulation (microcirculation disorder and midbrain infarction), anti⁃inflammatory and suppressive inflammatory response (non⁃specific inflammation, brainstem demyelination and eosinophilia) or interventional therapy (posterior communication aneurysm) were performed. After treatment, 31 cases (96.88%) showed remission of symptoms and 1 case (3.13%) had poor prognosis. Conclusions Microcirculation disorder is the main cause of TNP, and intracranial aneurysm is the most dangerous cause. Eye pain and pupil involvement are not the specific symptoms of intracranial aneurysms. Relevant examinations can actively improve the determination of the cause and appropriate treatment. Most patients have a good prognosis. DOI：10.3969/j.issn.1672⁃6731.2020.08.016

Keywords

• oculomotor nerve diseases
• ophthalmoplegia
• microcirculation
• inflammation
• intracranial aneurysm