Prognosis of paralysis of cranial nerves III, IV and VI at Menelik II Hospital
Keywords:Cranial nerve palsy III, Cranial nerve palsy IV, Cranial nerve palsy VI, Recovery, Deviation angle
Objective: Cases of cranial nerve 3, 4 and 6 palsies were analyzed regarding ultimate spontaneous recovery
with objective criteria.
Design: A longitudinal cohort study.
Methods: Patients presenting or referred as ocular nerve palsies to our center was done. History including age,
sex, history of trauma, and vascular risk factors was noted. Detailed clinical evaluation including ophthalmological
and neurological examination to diagnose the type of palsy was done. With an objective measurement patients
were followed for spontaneous recovery.
Results: A total of 112 cases were reviewed. The sixth cranial nerve was affected most frequently (n=60, 53.6%
of cases) followed by third cranial nerve (n=39, 34.8%), combined cranial nerves palsy (n=11, 9.8%) and fourth
cranial nerve (n=2, 1.8 %). Head trauma (n=48, 42.9%) was the most common aetiology. Recovery was evaluated
with reduction of deviation angle noted for 65 (58%) patients 6 months after the first presentation. Thirty four
(52.3%) patients showed partial recovery and 31 (47.7%) showed complete recovery. In binary logistic analysis,
vascular causes were found to be only significant factor associated with complete recovery (P=0.000).
Conclusion: Of the three studied nerves, the VI cranial nerve was the most commonly affected. Head trauma
was the main cause of the cranial nerve paralysis. With objective criteria based on deviation angle, overall
spontaneous recovery rate from the III, IV, and VI nerve palsy was 52.3%. Patients who had presumed vascular
disorders had a high chance of recovery.
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