Keywords
Cranial nerve palsy IV
Cranial nerve palsy VI
Recovery
Deviation angle
How to Cite
Abstract
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.
References
Harrison MJG. Contemporary neurology. Third
edition. Baltimore: Butter Worth; 1983;178.
Duane TD. Neuro ophthalmology. Cranial nerve
palsies. Chapter 19. Vol. 2. Revised edition.
Philadelphia: Lippincott Williams & Wilkims co;
;43.
Albert and Jackobie. Principles and practice of
ophthalmology. Second edition. Philadelphia:
W.B. Saunders Co; 1999.
Richards BW, Jones FR, Younge BR. Causes
and prognosis in 4278 cases of paralysis of the
oculomotor, trochlear, and abducens cranial
nerves. Am J Ophthalmol. 1992; 113(5): 489–
Berlit P. Isolated and combined pareses of cranial
nerves III, IV and VI. A retrospective study of
patients. J Neurol Sci.1991; 103(1):10-15.
Journal of Ophthalmology of Eastern Central and Southern Africa July 2020
Rush JA, Younge BR. Paralysis of cranial nerves
III, IV and IV cause and prognosis in 1000 cases.
Arch Ophthalmol. 1981; 99(1):76-79.
Jack J. Kanski. Clinical ophthalmology a systemic
approach. Fifth edition. Massachusetts: Butter
Worth – Heinmann publisher; 2003. chapter 18
pages 631-638.
Jacobson DM. Pupil involvement in patients
with diabetes-associated oculomotor nerve palsy.
Arch Ophthalmol. 1998; 116:723-727.
Rucker CW. Paralysis of the third, fourth, and
sixth cranial nerves. Am J Ophthalmol. 1958;
(6): 787–794.
Rucker CW. The causes of paralysis of the third,
fourth, and sixth cranial nerves. Am J Ophthalmol.
; 61(5): 1293–1298.
Park UC, Kim SJ, Hwang JM, Yu YS. Clinical
features and natural history of acquired third,
fourth, and sixth cranial nerve palsy. Eye. 2008;
(5): 691–696.
Akagi T, Miyamoto K, Kashii S, Yoshimura N.
Cause and prognosis of neurologically isolated
third, fourth, or sixth cranial nerve dysfunction in
cases of oculomotor palsy. Japan J Ophthalmol.
; 52(1):32-35.