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Kim HJ, Kim HJ, Choi JY, Yang HK, Hwang JM, Kim JS. Etiological distribution of isolated oculomotor nerve palsy: analysis of 633 patients and literature review. Eur J Neurol 2024; 31:e16261. [PMID: 38411317 DOI: 10.1111/ene.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND PURPOSE The etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of isolated oculomotor nerve palsy by recruiting patients from all departments in a referral-based university hospital. METHODS The medical records of 672 patients who had a confirmed diagnosis of isolated oculomotor nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020 were reviewed. A proportion of the etiology of isolated oculomotor nerve palsy was also compared with that of patients pooled from the previous studies that were searched on PubMed in May 2022. RESULTS The most common etiology was microvascular (n = 168, 26.5%), followed by vascular anomalies (n = 110, 17.4%), neoplastic (n = 86, 13.6%), inflammatory (n = 79, 12.5%), idiopathic (n = 60, 9.5%) and traumatic (n = 53, 8.4%). Neurologists were mainly involved in the management of microvascular and inflammatory oculomotor nerve palsies whilst ophthalmologists mainly participated in the care of idiopathic, neoplastic and traumatic palsies. Neurosurgeons mostly took care of oculomotor nerve palsy due to vascular anomalies. CONCLUSIONS The proportion of etiologies of isolated oculomotor nerve palsy may differ according to the specialties involved in the management. The results of previous studies on the etiological distribution of isolated oculomotor nerve palsy should be interpreted with this consideration.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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da Costa MDS, Lima JVF, Zanini MA, Hatamoto Filho PT, Naufal RFF, Reys L, Goes P, Miguez CA, Bastos FA, Lopes DDF, Dellaretti M, Buzartti I, Machado Filho MAS, Sako EA, Wainberg RC, Ferreira DS, Moura ALDA, Chaddad-Neto F. Risks for Oculomotor Nerve Palsy and Time to Recovery After Surgical Clipping of Posterior Communicating Artery Aneurysms: A Multicenter Retrospective Cohort Study. Neurosurgery 2023; 92:1192-1198. [PMID: 36752634 DOI: 10.1227/neu.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/07/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Aneurysms of the posterior communicating segment of carotid artery (PcomA) have a high risk of rupture; when these nonruptured aneurysms are associated with oculomotor nerve palsy (ONP), the risk of rupture increases compared with asymptomatic nonruptured PcomA. OBJECTIVE To retrospectively analyze the risk factors involved in ONP secondary to PcomA aneurysm and to study the factors involved in the recovery time of ONP once it is established. METHODS This was a retrospective study of patients from 10 neurosurgery centers from October 2008 to December 2020. We analyzed age at diagnosis, presence of compressive neuropathy of the oculomotor nerve, presence of aneurysm rupture, largest aneurysm diameter, aneurysm projection, smoking, hypertension, diabetes, time between diagnosis and surgical treatment, as well as the outcome. RESULTS Approximately 1 in 5 patients (119/511 23.3%) with a PcomA presented with ONP. We found that patients with aneurysms measuring greater than or equal to 7.5 mm were 1.6 times more likely to have ONP than those with aneurysms smaller than 7.5 mm. In our study, the prevalence of smoking in the PcomA + ONP group was 57.76%, and we also found that smokers were 2.51 times more likely to develop ONP. A total of 80.7% showed some degree of improvement, and 45.4% showed complete improvement with a median recovery time of 90 days. CONCLUSION This study showed that 80.7% of patients with PcomA aneurysms undergoing surgical treatment with aneurysm clipping showed some degree of improvement of the ONP, with a median time to recovery between 90 and 120 days.
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Affiliation(s)
| | - Joao Vitor Fernades Lima
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Marco Antonio Zanini
- Department of Neurosurgery, Faculdade de Medicina da Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Pedro Tadao Hatamoto Filho
- Department of Neurosurgery, Faculdade de Medicina da Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | | | - Lorena Reys
- Department of Neurosurgery, Hospital Regional de Presidente Prudente, Presidente Prudente, São Paulo, Brazil
| | - Pedro Goes
- Department of Neurosurgery, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Ahmed Miguez
- Department of Neurosurgery, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Azeredo Bastos
- Department of Neurosurgery, Hospital de Urgencias Governador Otavio Lage, Goania, Goiás, Brazil
- Department of Neurosurgery, Hospital de Neurologia Santa Monica, Goiania, Goiás, Brazil
| | - Dionisio de Figueiredo Lopes
- Department of Neurosurgery, Hospital de Urgencias Governador Otavio Lage, Goania, Goiás, Brazil
- Department of Neurosurgery, Hospital de Neurologia Santa Monica, Goiania, Goiás, Brazil
| | - Marcos Dellaretti
- Department of Neurosurgery, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil
- Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Israel Buzartti
- Department of Neurosurgery, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil
| | | | - Everson Akio Sako
- Department of Neurosurgery, Conjunto Hospitalar de Sorocaba - SECONCI, Sorocaba, São Paulo, Brazil
| | | | - Danilo Santos Ferreira
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Hospital Beneficencia Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
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Heo H, Lambert SR. Ocular Motor Nerve Palsy After Traumatic Brain Injury: A Claims Database Study. J Neuroophthalmol 2023; 43:131-136. [PMID: 36166785 PMCID: PMC10635738 DOI: 10.1097/wno.0000000000001635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is one of the common causes of ocular motor nerve (oculomotor nerve [CN3], trochlear nerve [CN4], and abducens nerve [CN6]) palsies, but there has been no large study of ocular motor nerve palsy caused by TBI. This study aimed to investigate the characteristics of and differences in ocular motor nerve palsy after TBI, according to patient age and severity of TBI. METHODS This was a population-based retrospective cohort study that included patients who had ocular motor nerve palsy after TBI with ≥6 months of continuous enrollment using claims data from the IBM MarketScan Research Databases (2007-2016). We assessed sex, age at the first diagnosis of TBI, the severity of TBI, and the rates of strabismus procedures according to the age and severity of TBI. The rates of muscle transposition surgery and chemodenervation in CN3, CN4, and CN6 palsy were investigated. RESULTS A total of 2,606,600 patients with TBI met the inclusion criteria. Among them, 1,851 patients (0.071%) had ocular motor nerve palsy after TBI. The median age of the patients was 39 (Q1-Q3: 19-54) years, and 42.4% of the patients were female. The median continuous enrollment period after the first diagnosis of TBI was 22 (Q1-Q3: 12-38) months. Of the 1,350,843 children with TBI, 454 (0.026%) had ocular motor nerve palsy. Of the 1,255,757 adults with TBI, 1,397 (0.111%) had ocular motor nerve palsy. Among these 1,851 patients, CN4 palsy (697, 37.7%) occurred most frequently, and strabismus procedures were performed in 237 patients (12.8%). CN6 palsy developed most frequently in children. More children (16.5%) underwent strabismus surgeries than adults (11.6%) ( P = 0.006). The proportion of CN4 palsy (52.3%) was higher while the proportion of CN3 palsy (15.5%) was lower in patients with mild TBI than in patients with moderate-to-severe TBI ( P < 0.001). CONCLUSIONS CN4 palsy developed most frequently among patients of all ages, and only approximately 13% of the patients underwent strabismus procedures for ocular motor nerve palsy after TBI. The rate of development of ocular motor nerve palsy was approximately 4.3 times lower in children than adults, and children most frequently had CN6 palsy after TBI.
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Affiliation(s)
- Hwan Heo
- Department of Ophthalmology (HH, SRL), Stanford University School of Medicine, Palo Alto, California; and Department of Ophthalmology (HH), Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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Pascual-Prieto J, Narváez-Palazón C, Porta-Etessam J, Gómez-de-Liaño R. COVID-19 epidemic: Should ophthalmologists be aware of oculomotor paresis? Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:361-362. [PMID: 32517875 PMCID: PMC7245284 DOI: 10.1016/j.oftal.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Affiliation(s)
- J Pascual-Prieto
- Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España.
| | - C Narváez-Palazón
- Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España
| | - J Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - R Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España
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Saad G, Ben Abdelkrim A, Beizig Maaroufi A, Njah Kacem M, Chaieb Chadli M, Ach K. Clinical patterns of third nerve palsies in diabetic patients. Tunis Med 2020; 98:513-517. [PMID: 33479970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Neuropathy is a frequent complication in diabetic patients with variable clinical presentations and evolutions. AIM The purpose of the study was to specify the clinical features of diabetic third nerve palsy, to assess the risk factors and to observe its evolution. METHODS We report a series of 11 diabetic patients with oculomotor paralysis collected in the department of endocrinology and diabetology of FarhatHached Hospital of Sousse between 1996 and 2005. RESULTS Our study was about 6 men and 5 women with an average age of 63.6 ± 13.7 years. All patients had type 2 diabetes. Eight patients presented with diplopia, three with periocular pain and 6 with headache. The oculomotor palsy was unilateral in all cases. All patients were in glycemic imbalance at the time of the diagnosis of ptosis and they were at high cardiovascular risk. The evolution under optimal equilibrium of diabetes and control of cardiovascular risk factors was marked by regression and disappearance in 4 patients, homo or contralateral recurrence in 4 patients and persistence of the palsy in 1 patient. CONCLUSION Glycemic equilibrium and ischemic phenomena due to cardiovascular risk factors are at the root of these oculomotor paralyses in diabetic patients. The evolution of diabetic mononevritis remains unpredictable despite the control of blood glucose levels and cardiovascular risk factors.
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Phuljhele S, Dhiman R, Sharma M, Kusiyait SK, Saxena R, Mahalingam K, Sharma P. Acquired Ocular Motor Palsy: Current Demographic and Etiological Profile. Asia Pac J Ophthalmol (Phila) 2020; 9:25-28. [PMID: 31990742 PMCID: PMC7004473 DOI: 10.1097/01.apo.0000617940.70112.be] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/27/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe the clinical, demographic, and etiological profile of patients of acquired ocular motor palsy presenting in a tertiary eye care center. DESIGN A retrospective hospital record-based study was conducted in patients of paralytic strabismus presenting from April 2016 to December 2017. METHODS Data included demographic and clinical details, diagnosis, underlying etiology, imaging, laboratory reports, and the outcome. RESULTS Mean age of presentation of 345 patients included in the study was 38.2 ± 19.5 years (range = 365 years). Pediatric patients (age: ≤16 years) constituted 9.5% of the entire cohort. Mean duration of complaints was 5.87 ± 2 months. Of the 372 eyes of 345 cases, 42.7% were sixth nerve palsy, 34.7% were third nerve palsy, 17.7% were fourth nerve palsy, and 4.8% had multiple ocular motor nerve involvement. Third and sixth nerve palsies were mostly due to ischemic event (58.1% and 69.8% cases, respectively), whereas fourth nerve palsies were commonly caused by trauma (63.6%). Amongst traumatic cases, road traffic accident was the most common mode of trauma. Systemic risk factors were preexistent in 18.2% cases (n = 63); in the remaining (40.8%; n = 141), they were diagnosed after presentation. Complete or partial recovery was noted in 69.7% cases in third nerve palsy, 67.9% cases in sixth nerve palsy, and 45% cases in fourth nerve palsy. CONCLUSIONS Acquired cranial nerve palsy has younger onset in Indian scenario. Ischemia is the most common etiology raising concerns about the health issues of young Indians. Sixth nerve is most commonly involved in all age groups. Low recovery rate in fourth nerve palsy can be attributed to traumatic etiology.
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Affiliation(s)
- Swati Phuljhele
- Strabismus and Neuro-Ophthalmology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
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Park SJ, Yang HK, Byun SJ, Park KH, Hwang JM. Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes. J Diabetes 2019; 11:379-385. [PMID: 30251398 DOI: 10.1111/1753-0407.12859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to define the risk of ischemic stroke among newly diagnosed type 2 diabetes (T2D) patients who developed ocular motor cranial nerve (CN) palsies. METHODS From the National Health Insurance Service - National Sample Cohort database (2002-2013) of a random sample of 1 025 340 Koreans, patients with newly diagnosed T2D aged ≥20 years were included in the study. The incidence of ocular motor CN palsies was identified using diagnostic codes for third, fourth, and sixth CN palsies. To determine the effect of incident ocular motor CN palsy on subsequent ischemic stroke, covariate Cox regression was used (Model 1 included only ocular motor CN palsy as a time-varying covariate; Model 2 included ocular motor CN palsy and demographic information; Model 3 included all variables in Model 2 as well as comorbidity, concomitant medication, and the Charlson comorbidity index score). RESULTS Of 45 820 T2D patients, 75 developed ocular motor CN palsy and 1411 had ischemic stroke. Four patients experienced ischemic stroke after the development of ocular motor CN palsy. Incident ocular motor CN palsy was associated with the subsequent risk of ischemic stroke in Models 1, 2 and 3 (hazard ratios [95% confidence intervals] 3.74 [1.40-9.98], 3.33 [1.25-8.89], and 2.96 [1.11-7.92], respectively). Male sex, older age, and lower income were associated with an increased risk of ischemic stroke. Among confounders, hypertension, atrial fibrillation, and congestive heart failure were associated with the risk of ischemic stroke. CONCLUSIONS Physicians should pay more attention to manageable risk factors of ischemic stroke when diabetic patients suffer from ocular motor CN palsies.
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Affiliation(s)
- Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
BACKGROUND Concussion and its associated sequel, postconcussion syndrome (PCS), have a debilitating impact on the lives of concussed patients. However, a diagnostic biomarker for this condition is lacking. Recently, there has been a surge of interest in using oculomotor function testing as an objective assessment of patients with PCS. OBJECTIVES To systematically synthesize, appraise, and summarize all published empirical studies that have assessed alteration of oculomotor functions in patients with PCS. METHODS Medline, Embase, PsychINFO, and CINAHL databases searched up to July 2016 for studies that used oculomotor function assessment in patients with postconcussion symptoms. RESULTS The search identified 1637 citations, and finally 8 case-control studies were included. Of these, 5 studies used a similar task with a target moving in a circular trajectory. Three other studies measured conventional oculomotor tasks such as saccade, vergence, and smooth pursuit eye movements. CONCLUSIONS Currently, there is limited support for the recommendation of oculomotor function assessments for diagnosis and identification of patients with PCS following head trauma. Therefore, more rigorous studies assessing oculomotor function changes in patients with PCS are warranted.
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Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada (Mr Taghdiri, Ms Varriano, and Dr Tartaglia); and Division of Neurology, University Health Network, Toronto Western Hospital, Canada (Dr Tartaglia)
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MacAskill MR, Myall DJ, Anderson TJ. "Ocular tremor" in Parkinson's disease: a technology-dependent artifact of universal head motion? Mov Disord 2013; 28:1165-6. [PMID: 23813923 DOI: 10.1002/mds.25602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 05/31/2013] [Indexed: 11/08/2022] Open
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Affiliation(s)
- R John Leigh
- Neurology Service, Veterans Affairs Medical CenterCleveland, Ohio, USA
- Department of Neurology, Case Medical Center, Case Western Reserve UniversityCleveland, Ohio, USA
- *Correspondence to: Dr. R. John Leigh, M.D. Department of Neurology, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106;
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Dhume KU, Paul KE. Incidence of pupillary involvement, course of anisocoria and ophthalmoplegia in diabetic oculomotor nerve palsy. Indian J Ophthalmol 2013; 61:13-7. [PMID: 23275215 PMCID: PMC3554988 DOI: 10.4103/0301-4738.99999] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 04/16/2012] [Indexed: 11/17/2022] Open
Abstract
AIMS To derive a reliable estimate of the frequency of pupillary involvement and to study the patterns and course of anisocoria in conjunction with ophthalmoplegia in diabetes-associated oculomotor nerve palsy. MATERIALS AND METHODS In this prospective analytical study, standardized enrolment criteria were employed to identify 35 consecutive patients with diabetes-associated oculomotor nerve palsy who were subjected to a comprehensive ocular examination. Standardized methods were used to evaluate pupil size, shape, and reflexes. The degree of anisocoria, if present and the degree of ophthalmoplegia was recorded at each visit. RESULTS Pupillary involvement was found to be present in 25.7% of the total number of subjects with diabetic oculomotor nerve palsy. The measure of anisocoria was < 2 mm, and pupil was variably reactive at least to some extent in all cases with pupillary involvement. Majority of patients in both the pupil-involved and pupil-spared group showed a regressive pattern of ophthalmoplegia. Ophthalmoplegia reversed much earlier and more significantly when compared to anisocoria. CONCLUSIONS Pupillary involvement in diabetes-associated oculomotor nerve palsy occurs in about 1/4 th of all cases. Certain characteristics of the pupil help us to differentiate an ischemic insult from an aneurysmal injury to the 3 rd nerve. Ophthalmoplegia resolves much earlier than anisocoria in diabetic oculomotor nerve palsies.
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Affiliation(s)
- Kaushik U Dhume
- Department of Neuro-Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Kiruba E Paul
- Department of Neuro-Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Panagiotopoulos V, Ladd SC, Gizewski E, Asgari S, Sandalcioglu EI, Forsting M, Wanke I. Recovery of ophthalmoplegia after endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2011; 32:276-82. [PMID: 21071536 DOI: 10.3174/ajnr.a2281] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recovery of aneurysm induced CNP after endosaccular coiling has been reported in the literature. The aim of this study was to assess in detail the parameters that affect the outcome after endovascular treatment of ophthalmoplegic aneurysms due CNP. MATERIALS AND METHODS Between November 1999 and March 2008, 30 consecutive patients (8 men, 22 women; mean age, 54.9 years) presenting with CNP underwent endosaccular coiling with or without additional use of stents in the parent artery. Subarachnoid hemorrhage was present in 10 patients, whereas 20 patients had unruptured aneurysms. The mean size of the aneurysms was 10 mm. Initial CNP was complete in 11 patients and partial in 19. Mean follow-up after coiling was 19 months. RESULTS The mean interval between the onset of CNP and aneurysm embolization was 48 days. Fifteen patients (50%) had complete recovery of oculomotor function, 12 had incomplete recovery (40%), and 3 (10%) remained unchanged after treatment. In 4 aneurysms (13.3%), 1 additional embolization was performed, whereas in 4 other aneurysms, 2 additional embolization procedures were necessary. Procedure-related permanent morbidity occurred in 2 patients (6.6%). CONCLUSIONS Endosaccular coiling is an effective and safe method for the treatment of ophthalmoplegic aneurysms. Age, neck size, and time of treatment do not seem to constitute prognostic factors with respect to CNP recovery, though patients with small aneurysms, unruptured status, and/or location in the posterior circulation showed a tendency for better outcome. The degree of initial CNP was the only statistically significant prognostic factor concerning the final outcome, resulting in better recovery, in case of incomplete initial CNP.
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Affiliation(s)
- V Panagiotopoulos
- Department of Diagnostic and Interventional Radiology, University Hospital of Essen, Germany
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Cabrejas L, Hurtado-Ceña FJ, Tejedor J. Predictive factors of surgical outcome in oculomotor nerve palsy. J AAPOS 2009; 13:481-4. [PMID: 19840728 DOI: 10.1016/j.jaapos.2009.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 08/13/2009] [Accepted: 08/14/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the outcomes and predictive factors of surgical treatment of oculomotor nerve palsy. METHODS Records of patients requiring eye muscle surgery for oculomotor nerve palsy in our institution were retrospectively reviewed. Age, sex, etiology, deviation, completeness of involvement, time between onset and surgery, botulinum toxin treatment, and number of surgical procedures were recorded as potential predictive factors. Muscle function, presence of diplopia, and torticollis were also recorded. The main outcome measure was motor function. Secondary outcome measures were presence of diplopia, torticollis, and limitation of muscle function. RESULTS Surgery was required in 22 patients, of whom motor success was obtained in 14 (63.6%). Frequency of diplopia and torticollis were significantly reduced by surgery. After multivariate regression analysis, longer time between onset and surgery (p = 0.03) and larger initial deviation (p = 0.05) were significantly associated with poorer postsurgical results in terms of motor function. CONCLUSIONS Longer time from onset to surgery and larger eye deviation are negative prognostic factors of postsurgical motor success for oculomotor nerve palsy.
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Omoti AE, Waziri-Erameh MJM. Pattern of neuro-ophthalmic disorders in a tertiary eye centre in Nigeria. Niger J Clin Pract 2007; 10:147-51. [PMID: 17902508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
AIM To determine the incidence and types of neuro-ophthalmic disorders at the eye clinic of University of Benin Teaching Hospital, Benin City, Nigeria. METHODS All the new patients presenting to the eye clinic of the University of Benin Teaching Hospital between May 2001 and April 2003 with neuro-ophthalmic disorders were interviewed, examined and investigated when possible. They were analysed in the context of age, gender, diagnosis, major clinical features and visual acuity. RESULTS A total of 76 patients with neuro-ophthalmic disorders were seen among a total of 1,698 new patients giving an incidence of 4.47%. The most common disorders were motor nerve palsies (27.6%), optic neuropathies (22.4%) and migraine (14.5%). The most presenting features were poor vision (39.5%), double vision (18.4%) and headache (17.1%). Twenty-nine patients (38.2%) were blind in the affected eye. CONCLUSION The incidence of neuro-ophthalmic disorders is relatively low but constitute a significant cause of ocular morbidity and blindness. Improvement in diagnostic facilities and awareness are required.
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Affiliation(s)
- A E Omoti
- Department of Ophthalmology, University of Benin Teaching Hospital, Benin-city, Nigeria.
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Abstract
Some visual processing deficits in developmental dyslexia have been attributed to abnormalities in the subcortical M stream and/or the cortical dorsal stream of the visual pathways. The nature of the relationship between these visual deficits and reading is unknown. The purpose of the present article was to characterize reading-related perceptual processes that may link the visual deficits to reading problems. We identified contrast sensitivity, position encoding, oculomotor control, visual attention, parafoveal/foveal interactions, and saccadic suppression as potential reading-related dorsal stream processes. We then evaluated the role of each process in reading and the status of each process in dyslexia. In theory, a number of dorsal stream processes (e.g., oculomotor control and visual attention) might contribute to reading problems in developmental dyslexia. More work is needed to demonstrate the connection empirically.
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Affiliation(s)
- Catherine Boden
- Department of Psychology, British Columbia's Children's Hospital, Vancouver, BC, Canada
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Brenner LA, Turner KC, Müller RA. Eye Movement and Visual Search: Are There Elementary Abnormalities in Autism? J Autism Dev Disord 2006; 37:1289-309. [PMID: 17120149 DOI: 10.1007/s10803-006-0277-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 07/22/2006] [Indexed: 10/23/2022]
Abstract
Although atypical eye gaze is commonly observed in autism, little is known about underlying oculomotor abnormalities. Our review of visual search and oculomotor systems in the healthy brain suggests that relevant networks may be partially impaired in autism, given regional abnormalities known from neuroimaging. However, direct oculomotor evidence for autism remains limited. This gap is critical since oculomotor abnormalities might play a causal role in functions known to be impaired in autism, such as imitation and joint attention. We integrate our oculomotor review into a developmental approach to language impairment related to nonverbal prerequisites. Oculomotor abnormalities may play a role as a sensorimotor defect at the root of impairments in later developing functional systems, ultimately resulting in sociocommunicative deficits.
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Affiliation(s)
- Laurie A Brenner
- Brain Development Imaging Laboratory, Department of Psychology, San Diego State University, 6363 Alvarado Ct. #225E, MC1863, San Diego, CA, 92120, USA
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18
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van der Wee NJ, Hardeman HH, Ramsey NF, Raemaekers M, Van Megen HJ, Denys DA, Westenberg HG, Kahn RS. Saccadic abnormalities in psychotropic-naive obsessive-compulsive disorder without co-morbidity. Psychol Med 2006; 36:1321-1326. [PMID: 16734943 DOI: 10.1017/s0033291706007926] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Oculomotor studies have found saccadic abnormalities in obsessive-compulsive disorder (OCD), lending support for models postulating a central role for inhibition in OCD. Saccadic abnormalities in OCD may also be potential candidates for a biological marker, important for more endophenotype-oriented research. Saccadic abnormalities have not been examined in psychotropic-naive patients with OCD without co-morbidity. METHOD We compared the error rates and latencies of 14 carefully selected adult psychotropic-naive patients with OCD with no co-morbid diagnosis and 14 pairwise matched healthy controls on a fixation task, on a prosaccade task and on an antisaccade task. RESULTS Patients with OCD showed normal error rates on all tasks, but latencies on the antisaccade task were significantly increased. CONCLUSIONS Our results indicate that patients with OCD have no gross impairment of oculomotor inhibitory capacities, but may have a disturbed capacity to deliberately initiate a saccade to an imagined target.
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Affiliation(s)
- Nic J van der Wee
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
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19
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Zakutniaia VN, Ametov AS, Gekht BM, Sidnev DV, Sanadze AG, Ivanova AN. [The differential diagnostic criteria and clinical features of endocrine ophtalmopathy in patients suffering from myastenia with oculomotor disturbances]. Klin Med (Mosk) 2006; 84:62-6. [PMID: 17087196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The article covers clinical and ophthalmologic characteristics of oculomotor disturbances in myastenic patients with endocrine ophtalmopathy, and differential diagnostic signs and peculiarities of endocrine ophtalmopathy in patients with a combination of the two diseases.
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20
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Serna-Candel C, Carneado-Ruiz J, Moltó-Jordà JM. [Neurovascular study in paresis of the ocular motor nerves]. Rev Neurol 2005; 40:702-3. [PMID: 15948075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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21
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Abstract
The authors report clinical and genetic study of 13 patients from three unrelated Tunisian families with an early onset cerebellar ataxia associated with oculomotor apraxia. Cerebellar ataxia with oculomotor apraxia 1 (AOA1) represents a clinically heterogeneous disease caused by mutations in the aprataxin gene. Two novel mutations were identified, the complete deletion of the gene, which seems to not correlate with an increased severity of the disease, and a splice mutation on the acceptor splice site of exon 7.
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Affiliation(s)
- R Amouri
- Institut National de Neurologie, Département de Biologie Moléculaire et de Neuropathologie,CNRS/INSERM Université Louis Pasteur, Illkirch, CHU de Strasbourg, France
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22
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Nygrén E, Müller K, Honkonen T. [Oculomotor abnormalities in schizophrenia]. Duodecim 2004; 120:545-52. [PMID: 15060991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Elina Nygrén
- Työterveyslaitos, työlääketieteen osasto lopeliuksenkatu 41 a A 00250 Helsinki.
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23
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Abstract
The aim of the study was to describe ocular motility in a sample of 56 patients affected by cerebral visual impairment (CVI) of hypoxic-ischemic origin. The sample consisted of 56 participants (37 males and 19 females), ranging in age from 2 to 16 years. In all cases CVI was associated with MRI-verified damage of the cerebral visual system. A complete ophthalmologic and neurological assessment was performed. Behaviour of gaze was studied in four conditions: during scanning of the surrounding environment, during fixation, execution of saccades, and pursuing. In addition, strabismus, nystagmus, and paroxysmal ocular deviations were evaluated. Ocular motility was studied by video recording the patients' eye motility during orthoptic examination. Each pattern of ocular motility studied revealed profound alterations in all the individuals examined. Typical features of ocular motility in CVI were: paroxysmal ocular deviations (present in 78%); the presence of variable angle strabismus (86%); and defective coordination of saccades (93%). Exploration of the environment and fixation were also impaired (88% and 84%, respectively). Disorders of initiation and performing saccades, absence of smooth pursuit, vergence abnormalities, nystagmus beats, instability of fixation, and difficulty in the systematic exploration of the environment were observed. These abnormalities characterize lack of gaze coordination found in children with brain damage. An early and detailed evaluation of ocular motility in individuals with CVI is important, especially when rehabilitation intervention is intended.
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Affiliation(s)
- Roberto Salati
- Paediatric Ophthalmology Department, Scientific Institute E Medea, Bosisio Parini (Lc), Italy.
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Abstract
OBJECTIVE To assess saccadic eye movements in boys with Tourette syndrome (TS) with and without attention-deficit hyperactivity disorder (ADHD), comparing performance with that of an age-matched group of male controls. METHOD Three different saccade tasks (prosaccades, antisaccades, and memory-guided saccades) were used to examine functions necessary for the planning and execution of eye movements, including motor response preparation, response inhibition, and working memory. The study included 14 boys with TS without ADHD (TS-only), 11 boys with TS and ADHD (TS+ADHD), and 10 male controls. RESULTS Latency of prosaccades was prolonged in boys with TS (both with and without ADHD) compared with controls. Variability in prosaccade latency was greater in the groups of boys with TS+ADHD compared with both the TS-only and control groups. Response inhibition errors on both the antisaccade task (directional errors) and memory-guided saccade task (anticipatory errors) were increased in boys with TS+ADHD compared with those with TS-only. There were no significant differences among the three groups in accuracy of memory-guided saccades. CONCLUSIONS Oculomotor findings suggest that TS is associated with delay in initiation of motor response as evidenced by excessive latency on prosaccades. Signs of impaired response inhibition and variability in motor response appear to be associated with the presence of ADHD.
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Affiliation(s)
- S H Mostofsky
- Kennedy Krieger Institute and the Department of Neurology at the Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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Horikoshi T, Nukui H, Yagishita T, Nishigaya K, Fukasawa I, Sasaki H. Oculomotor nerve palsy after surgery for upper basilar artery aneurysms. Neurosurgery 1999; 44:705-10; discussion 710-1. [PMID: 10201294 DOI: 10.1097/00006123-199904000-00008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The goals of this study were to evaluate the relationship between postoperative oculomotor nerve palsy and other clinical factors and to improve preoperative estimations of the risk. Such an evaluation has not been previously described in the literature. METHODS Patient records for 77 basilar tip aneurysm cases and 28 basilar superior cerebellar artery aneurysm cases treated between 1981 and 1997 were reviewed. Clinical and radiological parameters were separately analyzed using the chi2 test, and then multiple-regression analysis was used. RESULTS Postoperative oculomotor palsy occurred in 25 (32%) patients with basilar tip aneurysms and 11 (39%) patients with basilar superior cerebellar artery aneurysms, in addition to 2 patients with basilar tip aneurysms and 3 patients with basilar superior cerebellar artery aneurysms who exhibited oculomotor palsy before surgery. For both type of aneurysms, the size and direction of the aneurysms were closely related to oculomotor nerve palsy. The complication also tended to occur in early surgery cases, in younger patients, and in patients of poor-clinical grade status. CONCLUSION In this study, some clinical and radiological factors were found to be associated with postoperative oculomotor nerve palsy.
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Affiliation(s)
- T Horikoshi
- Department of Neurosurgery, Yamanashi Medical University, Tamaho, Japan
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Chadan N, Tamraz J, Chailloux E, Majdalani A, Abanou A, Chadan V. [Etiologic diagnosis of oculomotor paralysis by computerized tomography: a statistical approach. Apropos of 472 cases]. Ophtalmologie 1989; 3:114-21. [PMID: 2641087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Among 4,538 neuroradiology cases gathered at the NOHC of the XV-XX, an oculomotor paralysis is the 3rd (37.65%) clinical circumstances justifying a computerized tomography (directional plane by the neuro-ocular plane or PNO). The interpretation of the investigations requires to index them in 7 groups of items, therefore a computerized access follows (cross-sorting data). The injury of the VI overcomes (39.61%) followed by the one of the III (33.68%), and the IV (6.35%). In spite of limitations, the study puts forward and debates about etiological frequencies sometimes different from those in the literature.
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