JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2014.55.5.740 jkos-55-740 Original Article Risk Factors and Prognosis of Isolated Ischemic 3rd, 4th, 6th Cranial Nerve Palsy ChunJi Woong MD KimDae Hyun MD, PhD Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea Address reprint requests to Dae Hyun Kim, MD, PhD, Department of Ophthalmology, Chosun University Hospital, #365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea, Tel: 82-62-220-3190, Fax: 82-62-225-9839, E-mail: eyelovehyun@hanmail.net 08 201 30 08 2014 55 5 740 745 31 05 2013 12 11 2013 15 03 2014 Copyright © 2014 The Korean Ophthalmological Society 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To investigate the clinical features and risk factors of ischemic third, fourth, sixth cranial nerve palsy.

 Methods

Retrospectively, we reviewed the medical records of 46 eyes of 46 patients who were diagnosed with ischemic third, fourth, sixth nerve palsy alone such as age of onset, risk factors, recovery rate and recovery time.

 Results

The mean age of onset was 64.9 years. Of the 46 patients, 15 patients (32.6%) in third cranial nerve palsy group, 15 patients (32.6%) in fourth cranial nerve palsy group, 16 patients (34.8%) in sixth cranial nerve palsy group. The risk factor of hypertension in 30 patients (65.2%) was the most common than other risk factors such as diabetes, hyperlipidemia, elevated blood hematocrit, ischemic heart disease, left ventricular hypertrophy, smoking. The mean number of risk factors was 2.3 ± 0.5 in third cranial nerve palsy group, 1.6 ± 1.1 in sixth cranial nerve palsy group, 1.4 ± 1.1 in fourth cranial nerve palsy group. Of the 46 patients, 42 patients (91.3%) were recovered. There was no significant difference in recovery rate by cranial nerve palsy. Recovery time of intracranial abnormalities group (10.5 ± 2.9 weeks) in brain imaging study was late as compared with that of no intracranial abnormalities group (7.5 ± 5.1 weeks).

 Conclusions

The overall recovery rate of isolated ischemic third, fourth, sixth cranial nerve was high. But if there are intracranial abnormalities in imaging study, it took a long time to recover. Also ischemic third cranial nerve palsy had multiple risk factors characteristically.

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Distribution of patients with 3, 4, 6th cranial nerve palsy by combination of risk factor. HTN = hypertension; DM = diabetes mellitus; LVH = left ventricular hypertrophy.

Demographics of patients with cranial nerve palsy

3rd Nerve 4th Nerve 6th Nerve Total p-value
Patient number (%) 15 (32.6) 15 (32.6) 16 (34.8)   46 (100)
Age (years) 64.5 ± 11.8 62.5 ± 9.0 67.6 ± 9.7 64.9 ± 10.2 0.307*
Sex Male 7 9 10 26 (56.5)  
Female 8 6 6 20 (43.5)  
Duration to 1st exam (days) 8.3 ± 10.3 11.0 ± 10.6 11.7 ± 10.5 10.4 ± 10.3 0.255*
Total observed time (weeks) 37.7 ± 20.4 37.7 ± 19.7 37.4 ± 25.6 37.6 ± 21.7 0.536*

Values are presented as mean ± SD.

Kruskal-Wallis test among the each cranial palsy group by age, duration to 1st exam, total observed time.

Distribution of patients with cranial nerve palsy by risk factor

3rd Nerve (n = 15) 4th Nerve (n = 15) 6th Nerve (n = 16) Total (n = 46)
Hypertension (%) 11 (73.3) 8 (53.3) 11 (68.8) 30 (65.2)
Diabetes mellitus (%) 12 (80.0) 9 (60.0) 7 (43.8) 28 (60.9)
Hyperlipidemia (%) 5 (33.3) 2 (13.3) 4 (25.0) 11 (23.9)
Ischemic heart disease (%) 1 (6.7) 1 (6.7) 1 (6.3) 3 (6.5)
Left ventricular hypertrophy (%) 3 (20.0) 2 (13.3) 2 (12.5) 7 (15.2)
Smoking (%) 3 (20.0) 3 (20.0) 3 (18.8) 9 (19.6)
Hematocrit (%) 41.5 ± 2.5 38.4 ± 3.3 40.1 ± 4.0 40.0 ± 3.5

Values are presented as mean ± SD.

Distribution of patients within cranial nerve palsy group by summation of risk factor

3rd Nerve (n = 15) 4th Nerve (n = 15) 6th Nerve (n = 16) Total (n = 46) p-value
Risk factor
 1 0 (0%) 8 (53.3%) 8 (50.0%) 16 (34.8%)
 2-3 15 (100.0%) 7 (46.7%) 8 (50.0%) 30 (65.2%)
 Summation of risk factor 2.3 ± 0.5 1.4 ± 1.1 1.6 ± 1.1 1.8 ± 1.0 0.031*

Values are presented as mean ± SD.

Kruskal-Wallis test among the each cranial palsy group by summation of risk factor.

Type and distribution of intracranial abnormality

Intracranial abnormality 3rd Nerve (n = 4) 4th Nerve (n = 3) 6th Nerve (n = 5) Total (n = 12)
Lacunar infarction 1 0 4 5
Old thalamic infarction 0 0 1 1
Old cerebellar infarction 1 1 0 2
Midbrain infarction 1 0 0 1
Internal carotid artery stenosis 1 1 0 2
Old cerebral hemorrhage 0 1 0 1

Recovery rate and recovery time of the cranial nerve palsy in recovery group

3rd Nerve (n = 15) 4th Nerve (n = 15) 6th Nerve (n = 16) Total (n = 46) p-value
Recovery rate 14 (93.3%) 14 (93.3%) 14 (87.5%) 42 (91.3%) 0.554*
Recovery time (weeks) 9.3 ± 6.8 7.3 ± 3.0 8.0 ± 3.3 8.2 ± 4.7 0.464†
 One risk factor NA 5.9 ± 2.4 7.2 ± 2.2 6.5 ± 2.3 0.125‡
 2-3 risk factors 9.3 ± 6.8 9.0 ± 3.0 8.8 ± 4.2 9.1 ± 5.4
 Intracranial abnormality (+) 9.6 ± 1.1 12.1 ± 1.0 10.2 ± 4.9 10.5 ± 2.9 0.023‡
 Intracranial abnormality (—) 9.0 ± 8.1 6.3 ± 2.4 7.4 ± 2.8 7.5 ± 5.1

Values are presented as mean ± SD.

Pearson's Chi-square test among the each cranial palsy group;

Kruskal-Wallis test among the each cranial palsy group;

Mann-Whitney U test between the presence of risk factor, intracranial abnormality.