Department of Ophthalmology (JHK, HYC, HJ), School of medicine, Pusan National University, Busan, South Korea; and Biomedical Research Institute (HYC, HJ), Pusan National University Hospital, Busan, South Korea.
J Neuroophthalmol. 2022 Jun 1;42(2):234-238. doi: 10.1097/WNO.0000000000001426. Epub 2021 Oct 22.
Fourth cranial nerve palsy is the most common disease diagnosed in patients with vertical diplopia. Although it is reported to present a good prognosis, there are currently no agreed on prognostic factors that anticipate the recovery of the palsy other than the etiology. The purpose of this study was to investigate the prognostic factors of acquired fourth cranial nerve palsy.
The medical records of consecutive patients diagnosed with acquired unilateral fourth cranial nerve palsy from 2010 to 2020 and followed up for ≥6 months were retrospectively reviewed. The cause and degree of palsy, ocular deviation (horizontal, vertical, and cyclo), and fundus torsion were reviewed. The cause of palsy was classified as ischemic, traumatic, intracranial mass, others, or idiopathic. Patients were divided into 2 groups according to palsy recovery: complete recovery (group CR) or not CR (group NCR). The clinical characteristics of the 2 groups were compared, and the risk factors for incomplete recovery were investigated.
Thirty-five patients (25 men) were included in the study. The average age was 55.94 ± 16.11 years. CR was achieved in 23 patients (65.7%), and the time to recovery was 3.91 ± 4.03 months. The most common cause was traumatic (40.0%), followed by ischemia (37.1%), intracranial mass (11.4%), others (8.6%), and idiopathic (2.9%). The degree of palsy and fundus torsion was significantly higher in group NCR (P = 0.010 and P = 0.001). Severe oculomotor limitation, large fundus torsion, and intracranial mass cause rather than ischemic cause indicated a higher risk of incomplete or no recovery (P = 0.016, P = 0.009, and P = 0.043).
Identifying whether a patient has an intracranial mass, severe oculomotor limitation, or large fundus excyclotorsion may be useful for predicting the recovery of acquired unilateral fourth cranial nerve palsy.
第四颅神经麻痹是垂直复视患者最常见的诊断疾病。尽管据报道其预后良好，但除病因外，目前尚无公认的可预测麻痹恢复的预后因素。本研究旨在探讨获得性第四颅神经麻痹的预后因素。
回顾性分析 2010 年至 2020 年间连续诊断为单侧获得性第四颅神经麻痹并随访时间≥6 个月的患者的病历。回顾麻痹的病因和程度、眼球偏斜（水平、垂直和环向）和眼底扭转。将麻痹的病因分为缺血性、外伤性、颅内肿块、其他或特发性。根据麻痹恢复情况将患者分为 2 组：完全恢复（CR 组）或未完全恢复（NCR 组）。比较两组的临床特征，并探讨不完全恢复的危险因素。
本研究共纳入 35 名患者（25 名男性），平均年龄为 55.94±16.11 岁。23 名患者（65.7%）获得完全恢复，恢复时间为 3.91±4.03 个月。最常见的病因是外伤性（40.0%），其次是缺血性（37.1%）、颅内肿块（11.4%）、其他（8.6%）和特发性（2.9%）。NCR 组的麻痹程度和眼底扭转程度明显更高（P=0.010 和 P=0.001）。严重的动眼神经限制、较大的眼底外旋和颅内肿块引起而不是缺血性病因表明不完全或无恢复的风险更高（P=0.016、P=0.009 和 P=0.043）。
识别患者是否存在颅内肿块、严重动眼神经限制或较大的眼底外旋可能有助于预测单侧获得性第四颅神经麻痹的恢复情况。
