Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Oküler Motor Sinir Paralizilerinin Etiyolojisi, Klinik ve Prognostik Değerlendirmesi
Etiology, Clinical and Prognostic Evaluation of Oculomotor Nerve Paralysis
Mualla HAMURCUa, Özlem AKTAŞ ÖZALTUNa, Gülseren GÜL KOLAb, Murat Sinan SARICAOĞLUa
aAnkara Numune Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, Ankara, TÜRKİYE
bTrabzon Fatih Devlet Hastanesi, Göz Hastalıkları Kliniği, Trabzon, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2020;29(1):65-72
doi: 10.5336/ophthal.2019-65950
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışma 3, 4 veya 6. kraniyal sinir paralizilerinin etiyolojilerini belirlemek, seyir ve prognozlarını gözden geçirmek ve klinik yaklaşımları değerlendirmek amacıyla planlandı. Gereç ve Yöntemler: Kliniğimiz şaşılık ve nörooftalmoloji birimlerinde Ekim 1994-Ocak 2019 tarihleri arasında takip edilen ve 3, 4 veya 6. sinir parezi/paralizisi tanısı almış 162 hasta çalışmaya alınarak; dosyaları retrospektif olarak değerlendirildi. Hastalar etiyolojilerine göre; vasküler, konjenital, travma, neoplazm, anevrizma, idiyopatik ve diğer nedenler olmak üzere 7 alt gruba ayrıldı. Bulgular: 162 hastanın 67'si kadın 95'i erkek olup yaş ortalaması 32,4±28,2 (1-79) yıldı. Hastaların %21,0 (34) hasta 3. sinir, %33,3'ünde 4. sinir (54), %45,7 (74)'ünde 6. sinir tutulumu mevcuttu. Multipl sinir tutulumu ise 5/162 (%3,1) hastada saptandı. Tüm hastaların %11,7 (19/162)'sinde herhangi bir etiyolojik neden bulunamadı. Travma tüm oküler motor sinir paralizileri içinde 40 hasta ile (%24,6) en sık, ardından 38 (%23,4) hasta ile vasküler nedenler; etiyolojik nedeni oluşturdu. Üçüncü sinir paralizisi travma 9 (%26,4) hasta, 4. sinir paralizisinde travma 20 (%37,0) hasta ve 6. sinir paralizisinde travma 15 (%20,2) hasta ile en sık izlenen etiyolojik faktörlerdi. Tüm hastaların %44,8'inde tam veya kısmi iyileşme izlendi. Tam veya kısmi iyileşme görülen hastaların %48,6'sında vasküler patolojiler etiyolojik faktör olarak belirlendi. Stabil seyreden ve kısmi düzelme olan hastaların 59 (%81,9)'una kas cerrahisi yapıldı. İlk 6 aylık dönemde başlanan ve uyumu iyi olan 26 (%12,1) hastada, Fresnel prizması ve botoks enjeksiyonu ile düzelme sağlandı. Sonuç: Etiyolojide travma ve vasküler nedenlerin ilk sıralarda yer alması, hastaların bu açıdan ayrıntılı olarak sorgulanması ve incelenmesi gerektiğini göstermektedir. İdiyopatik hastalar hâlen oküler motor sinir paralizileri içinde büyük bir grubu oluşturmaktadır. Bu nedenle gerek etiyoloji, gerekse tedavi yaklaşımı açısından hastaların multidisipliner olarak değerlendirilmeleri gerekmektedir.

Anahtar Kelimeler: Oküler motor sinir paralizisi; üçüncü sinir paralizisi; dördüncü sinir paralizisi; altıncı sinir paralizisi
ABSTRACT
 Objective: This study was planned to determine the etiology of the third, fourth and sixth cranial nerve paralysis, to review their prognosis and to evaluate clinical approaches. Material and Methods: A hundred and sixty two patients who were followed up in our clinic in strabismus and neuroophthalmology units between October 1994-January 2019 and diagnosed as third, fourth or sixth nerve paresis/paralysis were included in the study, and their files were evaluated retrospectively. The patients were divided into 7 subgroups according to their etiology; vascular, congenital, trauma, neoplasm, aneurysm, idiopathic, and other results. Results: Of the 162 patients, 67 were female and 95 were male. The mean age was 32.4±28.2 (1-79) years. Thirty four (21.0%) patients had third cranial nerve, 54 (33.3%) patients had fourth cranial nerve, and 74 (45.7%) patients had sixth cranial nerve paralysis. Multiple nerve involvement was detected in 5/162 (3.1%) cases. No etiologic cause was found in 11.7% (19/162) of the all patients. In all ocular motor nerve paralysis, the trauma seemed to be the most frequent etiologic factor with the number of the patients being 40 (24.6%) followed by 38 (23.4%) cases with vascular causes. For the third cranial nerve paralysis trauma was the most frequent etiologic factor with the number of 9 (26.4%) patients, for the fourth cranial nerve paralysis trauma was the most frequent etiologic factor with the number of 20 (37.0%) patients and for the sixth cranial nerve paralysis trauma was the most frequent etiologic factors with the number of 15 (20.2%) patients. Complete or partial improvement was observed at about 44.8% of the patients. Vascular pathologies were determined as the etiologic factor in about 48.6% of the patients who were completely or partially improved. Muscle surgery was performed in 59 (81.9%) of the patients who were stable and had partial improvement. An improved was achived with Fresnel prism and botox injection in 26 (12.1%) patients who were started in the first six months period and had good compliance. Conclusion: The fact that trauma and vascular causes are in the first place in the etiology shows that cases should be investigated and examined in detail. Idiopathic cases still constitute a large group of ocular motor nerve paralysis. Therefore, in terms of etiology and treatment approach, cases should be evaluated as multidisciplinary.

Keywords: Ocular motor nerve paralysis; third nerve paralysis; fourth nerve paralysis; sixth nerve paralysis
REFERENCES:
  1. Rush JA, Younge BR. Paralysis of cranial nerves III, IV and VI cause and prognosis in 1000 case. Arch Ophthalmol. 1981;99(1):76-9. [Crossref]  [PubMed] 
  2. Richards BW, Jones FR Jr, Younge BR. Cause and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear and abducens cranial nerves. Am J Ophthalmol. 1992;113(5):489-96. [Crossref] 
  3. Rucker CW. The causes of paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol. 1966;61(5 Pt 2):1293-8. [Crossref] 
  4. Kodsi SR, Younge BR. Acquired oculomotor, trochlear and abducens cranial nerve palsies in pediatric patients. Am J Ophthalmol. 1992;114(5):568-74. [Crossref] 
  5. Holmes JM, Mutyala S, Maus TL, Grill R, Hodge DO, Gray DT. Pediatric third, fourth, and sixth nerve palsies: a population-based study. Am J Ophthalmol. 1999;127(4):388-92. [Crossref] 
  6. von Noorden GK, Murray E, Wong SY. Superior oblique paralysis. A review of 270 cases. Arch Ophthalmol. 1986;104(12):1771-6. [Crossref]  [PubMed] 
  7. Harley RD. Paralytic strabismus in children. Etiologic incidence and management of the third, fourth, and sixth nerve palsies. Ophthalmology. 1980;87(1):24-43. [Crossref] 
  8. Rucker CW. Paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol. 1958;46:787-94. [Crossref] 
  9. Miller NR. Solitary oculomotor nerve palsy in childhood. Am J Ophthalmol. 1977;83(1):106-11. [Crossref] 
  10. Mwanza JC, Ngweme GB, Kayembe DL. Ocular motor nevre palsy: a clinical and etiological study. Indian J Ophthalmol. 2006;54(3): 173-5. [Crossref]  [PubMed] 
  11. Ellis FD, Helveston EM. Superior oblique palsy: diagnosis and classification. Int Ophthalmol Clin. 1976;16(3):127-35. [Crossref] 
  12. Mansour AM, Reinecke RD. Central trochlear palsy. Surv Ophthalmol. 1986;30(5):279-97. [Crossref] 
  13. Chen CC, Pai YM, Wang RF, Wang TL, Chong CF. Isolated oculomotor nerve palsy from minor head trauma. Br J Sports Med. 2005;39(8):e34. [Crossref]  [PubMed]  [PMC] 
  14. Rush JA. Cause and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear and abducens cranial nerves. Am J Ophthalmol. 1992;114(6):777-8. [Crossref] 
  15. Moster ML, Savino PJ, Sergott RC, Bosley TM, Schatz NJ. Isolated sixth-nerve palsies in younger adults. Arch Ophthalmol. 1984; 102(9):1328-30. [Crossref]  [PubMed] 
  16. Peters GB 3rd, Bakri SJ, Krohel GB. Cause and prognosis of nontraumatic sixth nerve palsies in young adults. Ophthalmology. 2002;109(10):1925-8. [Crossref] 
  17. Nalçaçıoğlu P, Kavuncu S, Budakoğlu S, İlhan B, Acaroğlu G. [Ocular motor nerve palsies: clinical and etiological analysis]. Turkiye Klinikleri J Ophthalmol. 2016;25(4):238-44. [Crossref] 
  18. Dhaliwal A, West AL, Trobe JD, Musch DC. Third, fourth, and sixth cranial nerve palsies following closed head injury. J Neuroophthalmol. 2006;26(1):4-10. [Crossref]  [PubMed] 
  19. Park UC, Kim SJ, Hwang JM, Yu YS. Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy. Eye (Lond). 2008;22(5):691-6. [Crossref]  [PubMed] 
  20. Bianchi-Marzoli S, Brancato R. Third, fourth, and sixth cranial nerve palsies. Curr Opin Ophthalmol. 1997;8(6):45-51. [Crossref]  [PubMed] 

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