Long-term prognosis in patients with vasculopathic sixth nerve palsy.

PURPOSE

To better define the long-term prognosis in patients with a vasculopathic sixth nerve palsy (6NP), specifically addressing the degree of recovery and incidence of recurrent similar episodes.

DESIGN

Observational case series.

METHODS

Retrospective chart review.

SETTING

An outpatient neuroophthalmic practice.

STUDY POPULATION

Patients with one or more vascular risk factors and an acute, isolated 6NP that spontaneously recovered.

OBSERVATION PROCEDURE

Information regarding resolution of the 6NP, subsequent vascular events and recurrent ocular motor nerve palsy was obtained from chart review of follow-up clinic visits, mailed questionnaires and telephone interviews. The duration of follow-up ranged from 2 to 13 years.

MAIN OUTCOME MEASURES

Resolution of 6NP (complete or incomplete) and incidence of recurrent ocular motor nerve palsy.

RESULTS

Fifty-nine patients were identified with a mean age of 65.3 years +/- 11.6 (range 34-90 years). Fifty-one patients (86%) experienced complete resolution of their first episode of vasculopathic 6NP and eight patients (14%) had incomplete resolution. A subsequent episode of ocular motor mononeuropathy occurred in 18 of 59 (31%) patients. The number of recurrences ranged from one (in 14 patients) to four (in one patient). There was no association between any risk factor and recurrence of ocular motor nerve palsy. Similarly, incomplete resolution of the vasculopathic 6NP was not associated with any risk factor.

CONCLUSIONS

Patients with a vasculopathic 6NP usually have complete resolution of their ophthalmoplegia, but nearly one third of patients in our study later experienced at least one episode of recurrent vasculopathic ocular motor nerve palsy.