Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eye (Lond). 2019 Jun;33(6):965-973. doi: 10.1038/s41433-019-0353-y. Epub 2019 Feb 13.
To describe the causes of third, fourth, and sixth cranial nerve palsies in children and adolescents.
In this retrospective case series, a total of 66 patients aged 0-19 years with third, fourth, and sixth cranial nerve palsies seen in strabismus and neuro-ophthalmic practice from 2010 to 2017 were included. Causes of palsies were determined based on clinical assessment, high-resolution magnetic resonance imaging (MRI), and laboratory work-up.
Thirty-five patients had sixth cranial nerve palsy, 14 patients had third cranial nerve palsy (7 partial, 7 complete), 13 patients had fourth cranial nerve palsy, and 4 patients had combined cranial nerve palsies in this study. Neoplasia involving central nervous system was one of the most common causes of third, fourth, and sixth cranial nerve palsies both in children (age: 0-14 years) and adolescents (age: 15-19 years) (20% and 31%, respectively). Overall, neoplasia (23%) was the most common cause of acute third, fourth, and sixth cranial nerve palsies, followed by idiopathic cause (14%), inflammation (11%), and non-aneurysmal vascular contact (11%). Neoplasia was also the most common cause of sixth and third cranial nerve palsies (25% and 29%, respectively). The most common cause of fourth cranial nerve palsy was late decompensation in congenital fourth cranial nerve palsy (46%).
A substantial proportion of pediatric and juvenile patients had serious pathologies for third, fourth, and sixth cranial nerve palsies. If nerve palsies are indicated, prompt diagnosis of etiologies using high-resolution MRI with contrast and laboratory work-up are important for this disease population.
描述儿童和青少年第三、第四和第六颅神经麻痹的原因。
在这项回顾性病例系列研究中，共纳入了 2010 年至 2017 年斜视和神经眼科就诊的 66 名 0-19 岁的第三、第四和第六颅神经麻痹患者。根据临床评估、高分辨率磁共振成像（MRI）和实验室检查确定麻痹的原因。
在本研究中，35 例患者有第六颅神经麻痹，14 例患者有第三颅神经麻痹（7 例部分麻痹，7 例完全麻痹），13 例患者有第四颅神经麻痹，4 例患者有合并颅神经麻痹。中枢神经系统肿瘤是儿童（0-14 岁）和青少年（15-19 岁）第三、第四和第六颅神经麻痹的最常见原因之一（分别为 20%和 31%）。总体而言，肿瘤（23%）是急性第三、第四和第六颅神经麻痹的最常见原因，其次是特发性病因（14%）、炎症（11%）和非动脉瘤性血管接触（11%）。肿瘤也是第六和第三颅神经麻痹的最常见原因（分别为 25%和 29%）。第四颅神经麻痹的最常见原因是先天性第四颅神经麻痹的迟发性失代偿（46%）。
相当一部分儿童和青少年患者存在第三、第四和第六颅神经麻痹的严重病变。如果存在神经麻痹，使用对比增强高分辨率 MRI 和实验室检查及时诊断病因对该疾病人群非常重要。
