Ocular motor cranial nerve palsy and increased risk of stroke in the general population

et al. 2019

Sci Rep

We aimed to investigate the incidence, prevalence, and etiology of sixth cranial nerve (CN6) palsy in the general Korean population. The nationally representative dataset of the Korea National Health Insurance Service–National Sample Cohort from 2006 through 2015 was analyzed. The incidence and prevalence of CN6 palsy were estimated in the cohort population, confirming that incident cases of CN6 palsy involved a preceding disease-free period of ≥4 years. The etiologies of CN6 palsy were presumed using comorbidity conditions. Among the 1,108,256 cohort subjects, CN6 palsy developed in 486 patients during the 10-year follow-up. The overall incidence of CN6 palsy was estimated to be 4.66 per 100,000 person-years (95% confidence interval [CI], 4.26–5.08) in the general population. This incidence increased with age, accelerating after 60 years of age and peaking at 70–74 years of age. The mean male-to-female incidence ratio was estimated as 1.41 in the whole population, and the incidence and prevalence of CN6 palsy showed an increasing trend over time in the study period. Surgical incidence for CN6 palsy was only 0.19 per 100,000 person-years (95% CI, 0.12–0.29). The etiologies were presumed to be vascular (56.6%), idiopathic (27.2%), neoplastic (5.6%), and traumatic (4.9%). In conclusion, the incidence of CN6 palsy increases with age, peaking at around 70 years, and shows a mild male predominance in Koreans.

Section: Discussionmentioning

confidence: 99%

The incidence and etiology of sixth cranial nerve palsy in Koreans: A 10-year nationwide cohort study

Jung

Kim

et al. 2019

Sci Rep

“…Vascular aetiology was presumed if the patient had hypertension (I10-15), diabetes mellitus (DM; E11-14), ischaemic heart diseases (I20-25), peripheral vascular disease (I70, I73.1, I73.8, I73.9, and I79.2), or cerebrovascular disease (I60-68, G45, and G46) including vascular aneurysm (I67.1), stroke (I60, 61, 62, 63, and 64), and transient ischaemic attack (G45.8, G45.9) [18][19][20][21]. Patients with malignant neoplasm of eye and adnexa (C69), malignant neoplasm of meninges (C70), malignant neoplasm of brain (C71), malignant neoplasm of spinal cord, cranial nerves and other parts of central nervous system (C72), secondary malignant neoplasm of brain and cerebral meninges (C79.3), malignant neoplasm of nasopharynx (C11), malignant neoplasm of craniofacial bones (C41.00), benign neoplasm of meninges (D32), benign neoplasm of brain and other parts of central nervous system (D33), neoplasm of uncertain or unknown behaviour of meninges (D42), or neoplasm of uncertain or unknown behaviour of brain and central nervous system (D43) were classified into the intracranial neoplasm group [18,19]. Traumatic aetiology was defined in subjects with fracture of skull and facial bones (S02.0, S02.1, S02.3, S02.4, S02.7, and S02.8), contusion of eyeball and orbital tissues (S05.1), and intracranial injury (S06).…”

Section: Evaluation Of Cn4 Palsy Aetiologiesmentioning

confidence: 99%

The incidence and presumed aetiologies of fourth cranial nerve palsy in Korea: a 10-year nationwide cohort study

Jung

Kim

et al. 2021

Eye

Aims To investigate the incidence and presumed aetiologies of fourth cranial nerve (CN4) palsy in Korea Methods Using the nationally representative dataset of the Korea National Health Insurance Service-National Sample Cohort from 2006 to 2015, newly developed CN4 palsy cases confirmed by a preceding disease-free period of ≥4 years were identified. The presumed aetiology of CN4 palsy was evaluated based on comorbidities around the CN4 palsy diagnosis. Results Among the 1,108,292 cohort subjects, CN4 palsy newly developed in 390 patients during 10-year follow-up, and the overall incidence of CN4 palsy was 3.74 per 100,000 person-years (95% confidence interval, 3.38-4.12). The incidence of CN4 palsy showed a male preponderance in nearly all age groups, and the overall male-to-female ratio was 2.30. A bimodality by age-group was observed, with two peaks at 0-4 years and at 75-79 years. The most common presumed aetiologies were vascular (51.3%), congenital (20.0%), and idiopathic (18.5%). The incidence rate of a first peak for 0-4 years of age was 6.17 per 100,000 person-years, and cases in this group were congenital. The second peak incidence rate for 75-79 years of age was 11.81 per 100,000 person-years, and the main cause was vascular disease. Strabismus surgery was performed in 48 (12.3%) patients, most of whom (72.9%) were younger than 20 years. Conclusion The incidence of CN4 palsy has a male predominance in Koreans and shows bimodal peaks by age. The aetiology of CN4 palsy varies according to age-groups.

“…This difference between the present study and other studies could be due to the age and underlying disease(s) of the patients. Ocular motor nerve palsy is a significant risk factor for subsequent stroke, and the risk of stroke continues up to 12 years [ 11 – 14 ]; therefore, to prevent future strokes, it is advisable to start antiplatelet therapy for cases of ocular motor nerve palsy with an underlying predisposition.…”

Section: Discussionmentioning

confidence: 99%

“…It often improves spontaneously over time, and follow-up or symptomatic treatment (e.g., prism glasses), depending on the clinical course of the patients, may be attempted. In addition, considering the thrombus formation tendency of COVID-19 vaccines, such as AZ, it would be beneficial to consider antiplatelet therapy for future prognosis and prevention of stroke, especially if there are underlying diseases such as diabetes, hypertension, and hyperlipidemia [ 11 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study

Kang

2023

BMC Ophthalmol

Background There have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular motor nerve palsy, after coronavirus disease 2019 (COVID-19) vaccination. Therefore, this study aimed to report neuro-ophthalmological symptoms in patients after COVID-19 vaccination. Methods This was a retrospective study based on the medical records of 10 patients who visited our ophthalmology clinic in 2021 with symptoms, such as diplopia (nine patients) and decreased visual acuity (one patient), and showed findings, such as ocular motor nerve palsy, after vaccination against COVID-19. Results One patient had third nerve palsy, two had sixth nerve palsy, and five had fourth nerve palsy. One patient complained of subjective binocular diplopia but all test results were normal. One patient presented with decreased visual acuity accompanied by a sudden increase in intraocular pressure and orbital cellulitis in the other eye. The symptoms improved gradually in most patients. Compared with previous studies, this study reported three cases of antiplatelet therapy that was initiated due to the older age of the patients and underlying diseases. Conclusion As COVID-19 vaccines can cause neuro-ophthalmological diseases, such as ocular motor nerve palsy, patients’ age and underlying diseases should be considered while administering them.