A clinical study of etiological factors contributing to third, fourth and sixth cranial nerve palsies
Keywords:Cranial, ocular, muscles
Aim: To determine etiological factors contributing to third, fourth and sixth cranial nerve palsies. Objectives: To know the distribution of nerve palsies according to age. To determine distribution patterns of various etiologies of third, fourth and sixth cranial nerve palsies in different age groups. Materials and Methods: This is a prospective study of etiological factors contributing to ocular nerve palsies , 50 cases from outpatient department were selected for the purpose of study. Results: 50 Cases of ophthalmoplegia had been analysed which included both isolated and combined palsies. Isolated sixth nerve palsy was observed in 18 cases (36%),isolated third nerve palsy in 15 cases (30%).There was no single cases of isolated fourth nerve palsy in this study. The remaining 17 cases (34%) had involvement of 3 rd ,4 th and 6 th nerves in various combinations. In 4 out of 15 cases of isolated III nerve palsy (26.66%)there was pupil sparing. Of these 3 were cases of micro vascular ischemia and 1 case of meningioma with partial III nerve palsy. Out of the total cases in 5 cases (33.33%) there was bilateral involvement .Most of the cases of undetermined aetiology were of sixth nerve palsy(40%). Most common cause of third nerve palsy was inflammatory aetiology and sixth nerve palsy was trauma and tuberculosis. Third nerve was most commonly involved in the age group of 41-50 years (27.77%) and sixth nerve in the age group of 21-30 years and 41-50 years(22.72%). Inflammatory diseases (48%) were the most common aetiology in this study followed by trauma (14%) and undetermined aetiology(16%).Vascular aetiology was more common in elderly, trauma in middle age, tuberculosis in younger age group. Most of the patients showed (76.59%) showed either complete or partial recovery. Cases of vascular diseases and tuberculosis had more no. of cases with complete recovery (66.67% and 55.56%). All the cases of undetermined aetiology had complete recovery. In trauma and tumours, there was variable pattern of recovery. Conclusion: Isolated nerve palsies are more common than multiple ocular motor nerve palsies. Sixth nerve palsy is found to be more commonly involved followed by third nerve and multiple nerve palsies.
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