Clinical Course and Characteristics of Acute Presentation of Fourth Nerve Paresis

Khaier, Ayman; Dawson, Emma; Lee, John

doi:10.3928/01913913-20120710-05

Cited by 8 publications

(14 citation statements)

References 15 publications

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“…According to a previous report, decompensation of congenital CN4 palsy is the most frequent cause of acute vertical diplopia [ 8 , 9 ]. In a few patients diagnosed with congenital CN4 palsy, the range of fusion may be diminished by aging, stress or fatigue, especially in patients with a monocular decreased visual acuity [ 6 ]. However, vascular aetiology appears to be the main cause of acquired cranial nerve palsies, according to recent studies [ 3 , 4 , 6 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes and aetiology of fourth cranial nerve palsy with acute vertical diplopia in adults

2020

Eye

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Background We investigated the clinical outcomes of fourth cranial nerve (CN4) palsy with acute vertical diplopia in adults. Methods A total of 80 patients with acute CN4 palsy who underwent at least 3 months of follow-up were included in this study. We retrospectively investigated the aetiology, rate of recovery, and factors associated with recovery between March 2016 and January 2019. Results The average age of patients with CN4 palsy was about 60 years, and the duration of recovery was 1.5 months: 48 (60.0%) patients had a vascular aetiology and 17 (21.3%) patients had a trauma history. Brain lesions were found in four (5.0%) patients and decompensated cause accounted for four (5.0%) cases. Among the total of 80 patients, 13 (16.3%) failed to completely recover. Non-isolated CN4 palsy with other cranial nerve palsies were recorded in seven cases. The comparison between recovery and non-recovery groups showed that initial deviation angle, aetiology, fundus extorsion, and head tilt status were significantly different factors. Conclusion The recovery rate of acute CN4 palsy was about 80% and duration of recovery was 1.5 months. However, the varying rates and duration of recovery was presented according to aetiology thus we should consider the prognosis by aetiology.

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Section: Introductionmentioning

confidence: 99%

Clinical outcomes and aetiology of fourth cranial nerve palsy with acute vertical diplopia in adults

2020

Eye

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“…On examination, ipsilateral head tilt will exaggerate the strabismus (usually characterized by upward and outward deviation) and symptoms often abate upon contralateral head tilt. Approximately 90% of patients with an isolated ischemic CN IV palsy, as with our patient, will experience complete and spontaneous resolution within weeks to months 3,4 . Imaging is not indicated for cases of isolated fourth nerve palsies and patients can safely be referred to ophthalmology 1 …”

Section: Diagnosismentioning

confidence: 82%

“…Fourth nerve palsies are the most difficult to detect, and when isolated and in the absence of trauma, are almost always ischemic or congenital in etiology 2 . Additional etiologies like herpes zoster, migraine, giant cell arteritis, cavernous sinus thrombosis, and space‐occupying lesions should also be considered when signs and/or symptoms warrant (although these are exceedingly rare and unlikely to be isolated) 3,4 . This palsy often goes unnoticed because other extraocular muscles compensate.…”

Section: Diagnosismentioning

confidence: 99%

Man with diplopia on head tilt

Cooper

Steiner

2020

JACEP Open

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Prior Publication: None. 140COOPER AND STEINER exaggerate the strabismus (usually characterized by upward and outward deviation) and symptoms often abate upon contralateral head tilt.Approximately 90% of patients with an isolated ischemic CN IV palsy, as with our patient, will experience complete and spontaneous resolution within weeks to months. 3,4 Imaging is not indicated for cases of isolated fourth nerve palsies and patients can safely be referred to ophthalmology. 1

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“…18 Diabetes mellitus is the most common cause of isolated fourth nerve palsies and has a presumed microvascular etiology. 19 Although seventh nerve palsies and diabetes mellitus are reported concurrently in numerous case reports, no strong evidence that diabetes mellitus is pathogenic in facial palsy exists. Cranial neuropathies in diabetes mellitus tend to improve and may resolve over time.…”

Section: Other Diabetic Neuropathiesmentioning

confidence: 99%

Diabetic Neuropathies

Russell¹,

Zilliox²

2014

CONTINUUM: Lifelong Learning in Neurology

114

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Diabetic neuropathy is common and can present with varied clinical presentations discussed in this article. Although treatment currently focuses on pain management, attention should be paid to potential risk factors for neuropathy. For example, glycemic control, hyperlipidemia, and hypertension should be managed with diet, exercise, and medications. Class I or II clinical studies indicate that pregabalin, duloxetine, amitriptyline, gabapentin, and opioids are effective in the management of diabetic neuropathic pain.

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Clinical Course and Characteristics of Acute Presentation of Fourth Nerve Paresis

Abstract: The prognosis for complete and spontaneous resolution of microvascular fourth nerve paresis was excellent, with 89% completely resolved within 10 months.

Cited by 8 publications

References 15 publications

Clinical outcomes and aetiology of fourth cranial nerve palsy with acute vertical diplopia in adults

Clinical outcomes and aetiology of fourth cranial nerve palsy with acute vertical diplopia in adults

Man with diplopia on head tilt

Diabetic Neuropathies

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