Analysis the clinical characteristic and etiology of external ophthalmoplegia 257 cases
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Objective To discussion the clinical characteristics and etiology of external ophthalmoplegia. Methods Collected and retrospectively analyzed the etiology and clinical characteristic of 257 external ophthalmoplegia patients. Records of the patient history, clinical manifestations and corresponding neurological department of internal medicine, Ophthalmology, Endocrinology and Radiographic examination. Results Simple ptosis in 80 cases, 131 cases of simple binocular diplopia, ptosis and diplopia in 39 cases, 7 cases of eyeball fixation. 223 cases of unilateral paralysis of extraocular muscle, 32 cases of bilateral extraocular muscle paralysis. The levator paralysis in 119 cases, unilateral put on 98 cases of eyelid muscle paralysis, bilateral put on 21 cases of eyelid muscle paralysis. 84 cases of lateral rectus muscle palsy, 56 cases of unilateral lateral rectus muscle palsy, 6 cases of bilateral lateral rectus paralysis.178 cases of extraocular ophthalmoplegia of oculomotor control, 40 cases with complete paralysis, 117 cases with incomplete paralysis, combined with other extraocular ophthalmoplegia in 21 cases. Superior oblique palsy in 24 cases, alone of superior oblique palsy in 17 cases, combined with other extraocular ophthalmoplegia in 7 cases. 82 cases with orbital local pain, 12 cases with mydriasis. In 163 cases of ocular motor neuropathy patients, single oculomotor nerve palsy in 148 cases, accounting for 90.8%, 15 cases of multiple oculomotor nerve paralysis, 9.2%. Eye movement nerve injury in 110 cases, accounting for 67.5%, 16 cases, nuclear damage was 9.8%, between nuclear damage in 13 cases, accounting for 8%, nuclear damage 24 cases accounted for 14.7%.There are 14 kinds of external ophthalmoplegia etiology in this group. including myasthenia gravis, diabetic oculomotor nerve injury, atherosclerosis and ischemic ocular motor nerve injury, local nonspecific inflammatory, traumatic, local space-occupying lesions, thyroid disease, Increased intracranial pressure, intracranial posterior communicating artery aneurysm, Mitochondrial myopathy, carotid cavernous fistula, distant parts of the tumor, multiple sclerosis, local injection of botulinum toxin, progressive muscular dystrophy. In 86 cases with hypertension, 72 cases with diabetes, 22 cases of diabetes is found for the first time, 15 cases had paralysis of external ophthalmoplegia. Conclusions The main symptoms of ocular muscle paralysis is binocular diplopia and ptosis, The incidence of unilateral external ophthalmoplegia was higher than bilateral extraocular muscle paralysis, Oculomotor nerve innervation of extraocular ophthalmoplegia was the highest, followed by lateral rectus paralysis, paralysis of the superior oblique lower. Orbital pain and pupil change is paralysis of extraocular muscle common accompanied symptoms. Oculomotor nerve paralysis was the highest. Oculomotor nerve palsy with peripheral lesion was the highest. Patients with oculomotor nerve ophthalmoplegia in patients with a higher proportion of hypertension and Diabetes,. Extraocular muscle paralysis patients need regular inspections of fasting and postprandial 2 hour blood glucose, Underwent thyroid function, orbital CT, head CT and /or MRI examination, neostigmine test for external ophthalmoplegia patients in routine. For the extraocular ophthalmoplegia patients with dilated pupil, suggest underwent the DSA to exclusion the intracranial aneurysm.Keywords:
External ophthalmoplegia
Etiology
Lateral rectus muscle
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The ocular sequelae in nineteen patients who had suffered from a complete paralysis of the third cranial nerve were analyzed. In eleven of these patients, the paralysis was associated with an aneurysm of the internal carotid artery system. None of the cases in this group showed complete recovery of the third nerve function; however, six recovered sufficiently to permit binocular single vision in most fields of gaze. Two cases of aberrant regeneration of the third nerve were diagnosed.Trauma accounted for four cases of third nerve paralysis. One of these recovered completely and one showed features of aberrant regeneration. Of the cases of oculomotor paralysis associated with herpes zoster ophthalmicus, encephalitis, or an obscure etiology (two cases), all recovered completely.
Oculomotor nerve
Etiology
Abducens nerve
Trochlear nerve
Oculomotor nerve palsy
Cranial nerves
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Objective To investigate the characters of ocular motor abnormality in the early stage of brainstem infarction,and evaluate their value in the early diagnosis.Methods Two hundreds and eighty-seven patients with brainstem infarction were collected,in which 24 cases who were initially broke out as diplopia were chosen.Their clinical features,correlated examination and its related examination were retrospectively analyzed.Results There were 19 men and 5 women aged from 42 years old to 81 years old(Median:64 years old).The risk factors included hypertension in 20 cases(83.3%),coronary heart disease in 9 cases(37.5%),diabetes mellitus in 7 cases(29.2%),atrial fibrillation in 3 cases(12.5%).About 87.5% of patients complained with dizziness,and 16.7% with nausea,16.7% with limb ataxia,8.3% with vertigo,4.2% with limb weak.The infarcts of 9 patients(37.5%)were located in midbrain,14 patients(58.3%)in pons and 1 patient(4.2%)in medulla.Nuclear oculomotor nerve palsies were seen in the midbrain infarction,in which medial rectus weakness(8 cases)was dominant compared with other ocular muscles.The oculomotor disturbances of pons infarction were various,which included internuclear ophthalmoplegia in 3 cases,the abduct nerve palsy in 3 cases,the oculomotor nerve palsy in 2 cases,the pero-Horner syndrome in 1 case,and nystagmus in 10 cases.Conclusion In brainstem infarction,the characters of ocular motor abnormality mainly include nuclear ophthalmoplegia,internuclear ophthalmoplegia and nystagmus,which play the important roles in the early diagnosis.
Internuclear ophthalmoplegia
Abnormality
Pons
Neurological examination
Oculomotor nerve
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Paralytic strabismus in children is rare, occurring in about 0.1% of children. This rate is far less common than the 3% rate usually noted for comitant strabismus. The relative rates of ocular motor pareses were fourth nerve palsies in 36%, sixth in 33%, third in 22%, with multiple ocular motor nerve palsies in 9%. In a single population series from Minnesota, few cases were associated with neoplasm. However, institutional case series reports a high rate of neoplasm for acquired third nerve and sixth nerve palsies after excluding trauma and congenital causes. Tumor is rare in children with fourth cranial nerve palsies, usually associated with other neurologic disease. Rare causes of external ophthalmoplegia, to be considered when the motility pattern is variable or not fitting an ocular motor nerve pattern, include myasthenia gravis and congenital fibrosis of the extraocular muscles. Myasthenia most often presents as ptosis with exotropia. Rarer still is involvement of the extraocular muscles in childhood thyroid disease.
External ophthalmoplegia
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Objectives Oculomotor nerve palsy is a kind of disease with many causes, showing eye movement disorders, abnormal eyelid position, and/or damage of the pupil. The etiology of oculomotor nerve palsy in different departments is different. The study discussed the etiology, localization of the lesion, and prognosis for oculomotor nerve palsy firstly diagnosed in department of ophthalmology. Methods Clinical data of 137 hospitalized patients with oculomotor nerve palsy at the Department of Ophthalmology, the First Medical Center of PLA General Hospital from 2009 to 2018 were retrospectively collected. The etiology and its distribution characteristics in different age groups, the location of the lesion, and the prognosis of patients were analyzed. Results In 137 patients, the top 3 causes for oculomotor nerve palsy were head trauma (38.69%), cavernous sinus lesions (12.40%), and orbital inflammation (9.49%). Other causes included intracranial aneurysm, the intracranial space-occupying lesion, cerebral vessel diseases, infection, orbital tumors, diabetes, the operation of nasal cavity. Traumatic oculomotor nerve palsy was more common in young adults aged 20-49 years and in the patients with cerebral vascular disease in elderly people aged 60-69 years, while diabetic oculomotor nerve palsy is common in middle-aged and elderly people aged 50-69 years. The age distribution of other etiological types was relatively balanced. Seventy-five cases of orbital apex lesions were due to trauma, inflammation, infection, and tumor; 40 cases of cavernous sinus lesions were due to inflammation, tumor, and thrombosis; 6 cases of subarachnoid lesions were due to aneurysms, tumors, and trauma; 5 cases were oculomotor nucleus lesions were due to infarction; 11 cases could not be allocated because of unknown etiology. After treatment, the corrected visual acuity of oculomotor nerve palsy side was not significantly improved. The patients with oculomotor nerve palsy caused by intracranial aneurysm, cerebrovascular disease, and diabetes mellitus had the highest proportion of partial or complete recovery from ptosis and ocular dyskinesia. Conclusions Oculomotor nerve palsy is a common cause of ophthalmoplegia and diplopia. Head trauma, cavernous sinus lesions, and orbital inflammation are the most common causes for oculomotor nerve palsy first diagnosed in ophthalmology department. Traumatic oculomotor nerve palsy is common in adolescents. Oculomotor nerve palsy caused by diabetes and cerebrovascular disease are common in the middle-aged and elderly people. Most of the lesions locate in the orbital apex and cavernous sinus. The prognosis of corrected visual acuity is poor. The prognosis of ptosis and ocular dyskinesia caused by intracranial aneurysm, cerebrovascular disease, and diabetes is good. Figuring out the cause timely and accurately is the basis and key to treat oculomotor nerve palsy.
Oculomotor nerve palsy
Oculomotor nerve
Etiology
Superior orbital fissure
Cavernous sinus thrombosis
Abducens nerve
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Ophthalmoplegia or ophthalmoparesis are the terms given to paralysis or paresis of one or more of the extraocular muscles in one or both eyes. It may be representative of serious neurological or systemic disease. Other mechanisms may cause limitation of eye movement, including restrictive or myasthenic conditions, or combinations of several etiologies. Evaluating and differentiating the mechanisms causing ophthalmoplegia is important in determining the correct diagnosis and selecting the appropriate management in these complex cases.
Ophthalmoparesis
Paresis
Etiology
External ophthalmoplegia
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The aetiology of ophthalmoplegia in 15 patients with carotid-cavernous sinus fistula is discussed, and the clinical findings are correlated with angiographic and orbital CT appearances. After closure of the fistula the majority of patients with generalised ophthalmoplegia recovered full ocular movements rapidly, while patients with an isolated abduction weakness required much longer to return to normal. Orbital CT studies showed enlarged extraocular muscles in the patients with generalised ophthalmoplegia but muscles of normal size in those with abduction failure alone. After closure of the fistula repeat CT studies of patients with enlarged extraocular muscles showed a diminution in muscle size. We suggest that generalised ophthalmoplegia in carotid cavernous sinus fistula is due to hypoxic, congested extraocular muscles. Isolated abduction weakness is due to a sixth nerve palsy, which probably occurs either in the cavernous sinus or more posteriorly near the inferior petrosal sinus. A combination of these 2 mechanisms may be found in some patients.
External ophthalmoplegia
Orbit (dynamics)
Abducens nerve
Etiology
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Objective To probe the pathogenesis and treatment of ophthalmoplegia syndrome.Methods Retrospective study was performed in 46 hospitalized cases with ophthalmoplegia syndrome.They were diagnosed and treated based on neuro-ophthalmological examination,laboratory test,CT,MRI,DSA and so on.Results Among the factors responsible for opthalmoparalysis,intracranial aneurysms took the first place(16/46),followed by painful ophthalmoplegia syndrom(8/46),diabetes(8/46),craniocerebral injury(6/46),intracranial infection(4/46),medial rectus injury(2/46).As to the cranial nerves involved,oculomotor nerves ranked the first,followed by abducens nerve,nevertheless,trochlear nerve paralysis was relatively rare.Good outcomes were achieved through appropriate remedy.Conclusions The etiology for ophthalmoplegia syndrome was somehow complex.Careful examination and proper treatment option were required for this intricate syndrome.
Etiology
Abducens nerve
Oculomotor nerve
Tolosa–Hunt syndrome
Cranial nerves
Trochlear nerve
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External ophthalmoplegia
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Objective To evaluate clinical features of extraocular muscles paralysis that initially presented with diplopia.Methods Eighty cases with extraocular muscles paralysis were analyzed for causes of disease by reviewing medical history,a thorough physical examination and a complete eye examination.The clinical features were studied.Results Twenty-four patients with extraocular muscles paralysis were caused by diabetes,including oculomotor nerve paralysis(16 cases),abducent nerve paralysis(6 cases),and combination of oculomotor nerve and abducent nerve paralysis(2 cases).Twenty cases were caused by cerebrovascular diseases,and 18 cases were caused by arteriosclerosis resulted oculomotor and abducent nerve paralysis.Ten cases were caused by intracranial aneurysms,two cases by myasthenia gravis,one case by somatization disorder,two by intracranial tumors,one by multiple sclerosis,one by neurosyphilis,and 1 by brainstem encephalitis.Conclusions Many neurological diseases can cause nerve ophthalmic signs such as diplopia.The most common causes including diabetic ophthalmoplegia,cerebrovascular disease,and aneurysms ophthalmoplegia.Atherosclerosis is also an important cause.Other etiologies include myasthenia gravis(ocular),somatoform disorders,intracranial mass,etc.The etiology of patients with extraocular muscles paralysis and diplopia is complex and easy to be misjudged.Therefore,much attention should be paid to the exact diagnosis and proper management.
Abducens nerve
Etiology
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Objective To investigate the etiology, treatment and prognosis of oculomotor paralysis to raise the awareness of the disease for early treatment and as far as possible reduce the damage of complications. Methods 36 inpatients with unilateral oculomotor paralysis diagnosed in our hospital from April 2009 to June 2012 were retrospectively analyzed. Results The main cause of unilateral oculomotor paralysis in the article was the diabetic peripheral nerve paralysis(50.0%), followed by the basilar artery aneurysm(22.2%), Tolosa-Hunt syndrome(8.33%), trauma(8.33%).There were still l1.1% patients unable to clarify the causes after a series of examinations(such as DSA, MRI, internal carotid ultrasound).The prognosis was different for different causes. The most department having the patients with unilateral oculomotor paralysis was neurology department(21 cases), neurosurgery department(6 cases), endocrinology department(5 cases) and ophthalmology department(4 cases) in turn. Conclusion The cause of unilateral oculomotor paralysis is diverse; As the clinical data accumulate, the best treatment method of unilateral oculomotor paralysis caused by various etiological factors will determine. The patients with unilateral oculomotor paralysis should be fully considered the risk of intracranial aneurysm.
Etiology
Tolosa–Hunt syndrome
Oculomotor nerve
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