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

Affiliations
  • 1Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea.
  • 2Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. jisookim@snu.ac.kr
  • 3Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Yangsan, Korea.
  • 4Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Korea.
  • 5Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.
  • 6Department of Neurology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science and Regional Cardiocerebrovascular Center, Iksan, Korea.
  • 7Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
  • 8Department of Neurology, Chungnam National University School of Medicine, Daejeon, Korea.
  • 9Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea.

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
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