Retrospective Analysis of Factors Related to the Long-Term Recovery of Third, Fourth, and Sixth Cranial Nerve Palsy with Etiologies and Clinical Course in a Tertiary Hospital

Figures & data

Table 1 Demographic Data of Cranial Nerve Palsy

	Oculomotor Nerve Palsy		Trochlear Nerve Palsy		Abducens Nerve Palsy
	n	%	n	%	n	%
Age (year)
Mean ± SD	50.34 ± 18.12		54.75 ± 17.61		48.71 ± 17.79
Median (min-max)	51 (9–90)		54 (12–90)		50 (5–95)
<50	30	46.2	19	33.3	84	47.5
≥50	35	53.8	38	66.7	93	52.5
Onset (day)
Mean ± SD	29.46 ± 32.98		378.25 ± 825.93		84.25 ± 421.81
Median (min–max)	14 (1–120)		90 (0–3660)		7 (0–3660)
<7	19	29.2	9	15.8	72	40.7
≥7	46	70.8	48	84.2	105	59.3
Male	38	58.5	38	66.7	102	57.6
Diabetes mellitus	10	15.4	5	8.8	33	18.6
Hypertension	20	30.8	18	31.6	47	26.6
Dyslipidemia	10	15.4	14	24.6	22	12.4
Unilateral	63	96.9	54	94.7	155	87.6
Isolated cranial nerve palsy	55	84.6	54	94.7	143	80.8
Orbital apex syndrome	2	3.1	NA	NA	10	5.6
Etiology
Ischemic	16	24.6	7	12.3	37	20.9
Compressive	16	24.6	1	1.8	29	16.4
Trauma	13	20	18	31.6	48	27.1
Inflammation	10	15.4	5	8.8	39	22.0
Idiopathic	10	15.4	11	19.3	16	9.0
Congenital	NA	NA	15	26.3	NA	N
Carotid-cavernous fistula	NA	NA	NA	NA	8	4.5
Symptoms
Diplopia	65	100	NA	NA	176	99.4
Vertical diplopia	NA	NA	53	93	NA	NA
Torsional diplopia	NA	NA	3	5.3	NA	NA
Abnormal head posture	NA	NA	20	35.1	NA	NA
Facial asymmetry	NA	NA	11	19.3	NA	NA
Ptosis	19	29.2	NA	NA	NA	NA
Pain	9	13.8	4	7	30	16.9
Pupillary involvement	4	6.2	NA	NA	7	4.0
Esotropia	3	4.6	4	7	176	99.4
Exotropia	45	69.2	6	10.5	1	0.6
Vertical misalignment	47	72.3	56	98.2	NA	NA
Neuroimaging	63	96.9	45	79	162	91.5
Follow-up
Recovery period (months)
Mean ± SD	4.74 ± 3.45		5.39 ± 3.86		4.76 ± 10.06
Median (min-max)	4 (1–12)		5 (0.5–12)		3 (0.5–90)
Complete recovery	23	35.4	15	26.3	78	44.1
Strabismus manifestation	42	64.6	42	73.7	98	55.9
Ptosis	23	35.4	NA	NA	NA	NA
Pupillary involvement	4	6.2	NA	NA	2	1.2
Strabismus surgery	7	10.8	12	21.1	25	14.3
Ptosis surgery	1	1.5	NA	NA	NA	NA

Note: Data are presented as median (interquartile range) or n (%) of patients.

Abbreviations: SD, standard deviation; NA, not applicable.

Table 2 Recovery Rates by Etiology

	CN3 Palsy Recovery		CN4 Palsy Recovery		CN6 Palsy Recovery		p value
	Complete	No/Partial	Complete	No/Partial	Complete	No/Partial	CN3–CN4	CN3–CN6	CN4–CN6
Ischemic	9	7	4	3	19	18	0.965	0.738	0.771
Compressive	1	15	0	1	4	25	0.801	0.415	0.687
Trauma	5	8	2	16	30	18	0.075	0.106	0.000
Inflammation	6	4	2	3	15	24	0.464	0.209	0.931
Idiopathic	2	8	10	1	8	8	0.001	0.126	0.026
Congenital	NA	NA	5	10	NA	NA	NA	NA	NA
Carotic-cavernous fistula	NA	NA	NA	NA	2	6	NA	NA	NA

Note: Data are presented as number of patients.

Abbreviations: CN3, oculomotor nerve; CN4, trochlear nerve, CN6, abducens nerve; NA, not applicable.

Table 3 Logistic Regression of Factors Associated with Complete Recovery of Cranial Nerve Palsy

	Complete Recovery		No/Partial Recovery		p value	Crude Odds Ratio	95% CI	p value	Adjusted Odds Ratio	95% CI
	n	%	n	%
Cranial nerve palsy
Oculomotor nerve	23	35.4	42	64.6		1			1
Trochlear nerve	14	24.6	43	75.4	0.196	0.60	0.27–1.31	0.150	0.55	0.24–1.24
Abducens nerve	78	44.1	99	55.9	0.226	1.44	0.80–2.59	0.254	1.43	0.78–2.62
Age (years)
<50	45	33.8	88	66.2		1			1
≥50	70	42.2	96	57.8	0.142	1.43	0.89–2.29	0.096	1.60	0.92–2.79
Sex
Male	70	39.3	108	60.7		1			1
Female	45	37.2	76	62.8	0.709	1.10	0.68–1.76	0.976	0.99	0.60–1.64
Diabetes mellitus
Yes	21	43.8	27	56.3		1			1
No	94	37.5	157	62.5	0.412	1.30	0.70–2.43	0.981	0.99	0.47–2.08
Hypertension
Yes	35	41.2	50	58.8		1			1
No	80	37.4	134	62.6	0.543	1.17	0.70–1.96	0.876	1.05	0.54–2.04
Dyslipidemia
Yes	18	39.1	28	60.9		1			1
No	97	38.3	156	61.7	0.919	1.03	0.54–1.97	0.961	1.02	0.49–2.13
Onset (days)
≥7	66	33.2	133	66.8		1			1
<7	49	49	51	51	0.008	1.94	1.19–3.16	0.038	1.73	1.03–2.89
Isolated
Isolated cranial nerve palsy	104	41.3	148	58.7	0.023	2.30	1.12	0.014	2.56	1.21–5.39
Multiple cranial nerve palsies	11	23.4	36	76.6		1			1

Note: Data are presented as median (interquartile range) or n (%) of patients.

Abbreviation: CI, confidence interval.

Table 4 Compared Etiologies of Isolated Third, Fourth, and Sixth Cranial Nerve Palsy (%)

Nerve Palsy	Etiologies	Rush JA et al^Citation4 (1981)	Tiffin PA et al^Citation5 (1996)	Park UC et al^Citation10 (2008)	Kim K et al^Citation7 (2018)	Park KA et al^Citation16 (2019)	Our Study
Oculomotor nerve palsy	Vascular	20.7	46	35	63.5	4.5	24.6
	Head trauma	16.2	0	18.8	4.8	13.6	20
	Neoplastic	11.7	7	6.3	3.2	18.2	24.6
	Aneurysm	13.8	0	10.4	1.6	9.1	0
	Other	14.5	14	10.4	NA	50	15.4
	Undetermined	23.1	32	18.8	26.9	4.5	15.4
Trochlear nerve palsy	Vascular	18.6	26	37	54.3	28.3	16.7
	Head trauma	32	26	30.4	14.3	19.6	42.9
	Neoplastic	4.1	0	0	5.7	4.3	2.4
	Aneurysm	1.7	0	0	0	4.3	0
	Other	7.6	3	4.3	NA	26.1	11.9
	Undetermined	36	46	28.3	25.7	17.4	26.2
Abducens nerve palsy	Vascular	17.7	33	27.8	45.5	13.6	20.9
	Head trauma	16.7	3	19.4	9	6.8	27.1
	Neoplastic	14.6	1	5.6	9	37.3	16.4
	Aneurysm	3.6	1	4.6	5.5	10.2	0
	Other	17.9	28	18.5	NA	16.9	26.5
	Undetermined	29.6	33	24.1	30.9	15.3	9.0

Note: Data are presented as percentage of patients.

Abbreviation: NA, not applicable.

Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1000 cases. Arch Ophthalmol. 1981;99(1):76–79. doi:10.1001/archopht.1981.03930010078006

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Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.