J Korean Ophthalmol Soc.  2020 Nov;61(11):1338-1347. 10.3341/jkos.2020.61.11.1338.

Clinical Features and Course of Acquired Third Cranial Nerve Palsy

• Lee JH
• Lee EC
• Oh SY

• KMID: 2511271
• DOI: http://doi.org/10.3341/jkos.2020.61.11.1338

Abstract

Purpose
The purpose of our study was to investigate the clinical features and course of acquired third cranial nerve (CN3) palsy.
Methods
We retrospectively reviewed the medical records of 40 consecutive patients who underwent at least 3 months of follow-up clinical evaluation from March 2016 to December 2019 who were admitted to the ophthalmologic department or referred from other departments of Samsung Changwon Hospital and diagnosed with acquired CN3 palsy.
Results
The average age of patients with acquired CN3 palsy was about 64.6 ± 15.9 years and the mean follow-up period was 4.4 ± 8.4 months. Microvasculopathy (twelve patients, 30.0%) was the most common etiology followed by brain vascular lesions (eight patients, 20.0%), and tumors (eight patients, 20.0%). The complete recovery rate was 67.5% and non-isolated CN3 palsy was recorded in 30.0% cases of which six cranial nerve palsy (in eight patients, 66.7%) was the most common. Microvasculopathy (42.9%) and tumors (66.7%) were the most common features in the recovery and persistent groups, respectively. Extraocular movement limitation at the first visit was smaller in the recovery group (−2.4 ± 1.1) than in the persistent group (−3.2 ± 0.6); the difference was statistically significant (p = 0.039). Pupil involvement was found in one (8.3%) patient from the microvascular group and in eight (61.5%) patients from the compressive lesion group.
Conclusions
The microvascular group or those with a low degree of extraocular movement limitation at the first visit had the highest recovery rate in acquired CN3 palsy. Although compressive lesions showed high pupillary involvement, imaging study should be considered for confirmation rather than attempting to discriminate the causative disease based solely on pupil involvement.

Keyword

Isolated; Oculomotor nerve palsy; Paralytic strabismus; Pupil; Recovery