Clinical Ophthalmology (Feb 2024)
Retrospective Analysis of Factors Related to the Long-Term Recovery of Third, Fourth, and Sixth Cranial Nerve Palsy with Etiologies and Clinical Course in a Tertiary Hospital
Abstract
Worapot Srimanan, Somboon Panyakorn Ophthalmology Division, Phramongkutklao Hospital, Bangkok, ThailandCorrespondence: Worapot Srimanan, Ophthalmology division, Phramongkutklao hospital, 315 Ratchawithi Road, Thung Phayathai Subdistrict, Ratchathewi, Bangkok, Thailand, Tel +662-763-9300, Fax +662-354-9309, Email [email protected]: Although various studies have explored the causes and clinical aspects of cranial nerve palsies, there remains a significant gap in understanding the prognostic factors that influence outcomes. In this study, we sought to address this gap by investigating the incidence, etiologies, clinical courses, and factors associated with long-term recovery, with the aim of enhancing the knowledge base in this field and providing valuable insights for improved patient care.Patients and Methods: This retrospective study evaluated the data gathered from subjects who had third, fourth, and sixth cranial nerve palsy at the ophthalmology outpatient clinic of Phramongkutklao Hospital between April 1, 2012, and April 30, 2022.Results: Among the three nerves, abducens nerve palsy was the most prevalent finding by most commonly involved. Our study revealed that ischemic and compressive lesions were the most common etiology of oculomotor nerve palsy, comprising 24.6% each. In addition, the most common etiology of trochlear and abducens nerve palsy was trauma, at 31.6% and 27.1%, respectively. Compared with the other nerves, oculomotor nerve palsy was associated with a shorter duration onset of symptoms and recovery period. The best recovery outcomes among the various etiologies were inflammation, ischemic events, and trauma in oculomotor, trochlear, and abducens nerve palsy, respectively. Logistic regression revealed that an onset of < 7 days and isolated nerve involvement were significantly associated with good long-term outcomes, with an adjusted odds ratio of 1.73 (95% confidence interval, 1.03– 2.89) and 2.56 (95% confidence interval, 1.21– 5.39) adjusted for the type of cranial nerve palsy, aged at 50 years, sex, diabetes mellitus, hypertension, dyslipidemia, onset at 7 days, and number of cranial nerves involved, respectively.Conclusion: The onset of symptoms in less than 1 week and isolated nerve involvement were associated with better prognosis in subjects with third, fourth, and sixth cranial nerve palsy.Plain Language Summary: This study aimed to fill a gap in our understanding of cranial nerve palsies, which affects eye movements and coordination. We investigated the causes, clinical courses, and factors influencing long-term recovery in patients with third, fourth, and sixth cranial nerve palsy. We studied the data obtained from patients at an ophthalmology clinic over a 10-year period.Abducens nerve palsy was the most common among these conditions. Ischemia and compression were observed to be the leading causes of oculomotor nerve palsy, whereas trauma was the primary cause of trochlear and abducens nerve palsy. Oculomotor nerve palsy had the shortest onset and recovery time compared with other nerves. The best recovery outcomes were observed in cases of inflammation, ischemic events, and trauma for oculomotor, trochlear, and abducens nerve palsy, respectively.The study also found that a rapid onset of symptoms in less than 7 days and involvement of only one nerve were associated with better long-term outcomes. This information can help doctors provide better care and more accurate prognoses to patients with cranial nerve palsies.Keywords: oculomotor, trochlear, abducens, nerve palsy, outcome, prognosis
