Early progression of ophthalmoplegia in patients with ischemic oculomotor nerve palsies.

OBJECTIVE

To describe the frequency and clinical correlates of early progression of ophthalmoplegia in patients with ischemic oculomotor nerve palsies.

DESIGN

Cohort survey, case series.

SETTING

Multispecialty clinic providing primary, secondary, and tertiary care in central and northern Wisconsin.

PATIENTS

Sixteen patients evaluated within 1 week of the reported onset of ischemic oculomotor nerve palsy were identified and followed up prospectively using a standardized ophthalmoplegia grading scheme. All patients were followed up serially until their ophthalmoplegia resolved.

MAIN OUTCOME MEASURES

Descriptive analysis of the temporal course of ophthalmoplegia and frequency of progression of deficits. Comparison between the group that had progression of ophthalmoplegia with the group that did not for age, hematocrit, cholesterol level, and adiposity; presence of diabetes, hypertension, hypercholesterolemia, and coronary artery disease; history of stroke; and tobacco use.

RESULTS

Eleven (69%) of 16 patients had progression of ophthalmoplegia. The median time between reported onset and peak severity of ophthalmoplegia was 10 days. The only important difference between the progressive and nonprogressive groups was a shorter time to resolution of ophthalmoplegia for the nonprogressive group.

CONCLUSIONS

Early progression of ophthalmoplegia occurs often in patients with ischemic oculomotor nerve palsies. The power to find differences between progressive and nonprogressive groups was limited by the small number of patients available for analysis.