Verma Vidhya, Singh Priti, Karkhur Samendra, Verma Mahesh
Ophthalmology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Radiodiagnosis, Chirayu Medical College and Hospital, Bhopal, IND.
Cureus. 2025 Apr 19;17(4):e82588. doi: 10.7759/cureus.82588. eCollection 2025 Apr.
Impairment of the third, fourth, sixth, and seventh cranial nerves can lead to neuro-ophthalmic symptoms that severely affect visual function and quality of life. This study aimed to evaluate the clinical profile, etiological spectrum, and anatomical localization of ocular cranial nerve palsies involving the third, fourth, sixth, and seventh cranial nerves in patients presenting to a tertiary healthcare center in central India.
This 12-month cross-sectional observational study involved 30 patients presenting with diplopia, headache, facial asymmetry, or restricted ocular movements. Patients aged 18 years or older diagnosed with palsy of the third, fourth, sixth, or seventh cranial nerve were included. A detailed history, neuro-ophthalmic examination, and imaging (CT or MRI) were performed. Data analysis was conducted using descriptive statistics, with categorical variables expressed as frequencies and percentages and continuous variables summarized as means and standard deviations.
A total of 30 patients meeting the inclusion criteria were studied. Isolated seventh cranial nerve palsy was the most common, occurring in 12 patients (40%), which caused facial weakness and lagophthalmos. It was followed by isolated sixth cranial nerve palsy in 10 patients (33.3%), which led to diplopia and headache. Isolated third cranial nerve palsy was noted in five cases (16.7%). Mixed motor nerve palsies involving the third, fourth, sixth, and seventh cranial nerves were seen in three cases (10%). Notably, no patients presented with isolated trochlear (fourth nerve) palsy. Bell's palsy, trauma, and diabetes were the leading causes.
Seventh cranial nerve palsy was the most common, with Bell's palsy as the leading cause. Sixth cranial nerve palsy, primarily due to trauma-induced raised intracranial tension, was the second most frequent. Third cranial nerve palsy was mostly linked to diabetes, while cavernous sinus thrombosis was the main cause of multiple cranial nerve palsies. Larger studies are necessary to further validate these findings.
第三、第四、第六和第七颅神经损伤可导致严重影响视觉功能和生活质量的神经眼科症状。本研究旨在评估印度中部一家三级医疗中心就诊患者中累及第三、第四、第六和第七颅神经的眼部颅神经麻痹的临床特征、病因谱和解剖定位。
这项为期12个月的横断面观察性研究纳入了30例出现复视、头痛、面部不对称或眼球运动受限的患者。纳入年龄在18岁及以上、被诊断为第三、第四、第六或第七颅神经麻痹的患者。进行了详细的病史采集、神经眼科检查和影像学检查（CT或MRI）。数据分析采用描述性统计，分类变量以频率和百分比表示，连续变量以均值和标准差汇总。
共研究了30例符合纳入标准的患者。孤立性第七颅神经麻痹最为常见，有12例（40%），导致面部无力和兔眼症。其次是孤立性第六颅神经麻痹，有10例（33.3%），导致复视和头痛。孤立性第三颅神经麻痹有5例（16.7%）。3例（10%）出现累及第三、第四、第六和第七颅神经的混合运动神经麻痹。值得注意的是，没有患者出现孤立性滑车神经（第四神经）麻痹。贝尔麻痹、外伤和糖尿病是主要病因。
第七颅神经麻痹最为常见，贝尔麻痹是主要病因。第六颅神经麻痹主要由于外伤引起颅内压升高，是第二常见的病因。第三颅神经麻痹大多与糖尿病有关，而海绵窦血栓形成是多颅神经麻痹的主要原因。需要更大规模的研究来进一步验证这些发现。
