Spontaneous recovery rates for unilateral sixth nerve palsies

King, Anthony J; Stacey, Emma; Stephenson, Gail; Trimble, R. B.

doi:10.1038/eye.1995.110

Cited by 54 publications

(31 citation statements)

References 7 publications

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“…1,[4][5][6]10 Wide ranges of recovery rates is thought to result from variable criteria for recovery among the studies and criteria that are often not well defined. The use of objective criteria like ours, based on eyeball deviation and motor restriction in patients who visited the clinic shortly after onset, may be helpful to obtain more consistent recovery rates.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy

et al. 2007

Eye

130

119

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Purpose Clinical features of acquired third, fourth, and sixth cranial nerve palsy showed variation among previous studies. Evaluation of natural course with objective criteria will establish accurate recovery rates and important factors for recovery. Methods Retrospective chart review was performed on 206 patients who visited a neuro-ophthalmic department with acquired third, fourth, and sixth nerve palsy. Aetiology and results of ocular exam on each visit were reviewed, and multivariate logistic regression analysis was performed to identify independent factors affecting recovery. Results The sixth cranial nerve was affected most frequently (n ¼ 108, 52.4%) and vascular disease (n ¼ 64, 31.1%) was the most common aetiology. Recovery was evaluated with change of deviation angle for 108 patients, who were first examined within a month of onset and followed up for at least 6 months. Ninety-two (85.2%) patients showed overall (at least partial) recovery and 73 (67.6%) showed complete recovery. In univariate analysis, initial deviation angle was found to be only significant factor associated with complete recovery (P ¼ 0.007) and most patients who experienced successful management of treatable underlying disease showed recovery. Conclusions With objective criteria based on deviation angle, overall recovery rate from the third, fourth, and sixth nerve palsy was 85.2%. Patients who had smaller initial eyeball deviation or successful management of treatable underlying disease had a high chance of recovery.

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Section: Discussionmentioning

confidence: 99%

Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy

et al. 2007

Eye

130

119

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“…Although the overall recovery rate is high in acute traumatic sixth nerve palsy or paresis, a complete or bilateral case has a poor prognosis and is more likely to need strabismus surgery." (9) King et all found a spontaneous recovery rate in their series of 78.4%, but traumatic etiology was excluded (10). On the other hand, Mutyala and Holmes stated that "Spontaneous recovery from isolated traumatic sixth-nerve palsy may be lower than previously reported.…”

Section: Discussionmentioning

confidence: 45%

Therapeutic results in sixth nerve palsy

Prună¹,

Cioplean²,

Voinea³

2015

Romanian Neurosurgery

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Authors aim to assess through a retrospective study the efficiency of different therapeutic methods used in VIth nerve palsy. 60 patients with VIth nerve palsy, admitted and treated in Oftapro Clinic, were divided into two groups: a group with partial dysfunction (paresis) of sixth nerve and a group with the complete abolition of neuromuscular function (VIth nerve palsy). Initial examination included assessment of neuromuscular function, binocular vision and existence of medial rectus muscle contracture (ipsi-and contralateral) and contralateral lateral rectus inhibitory palsy. Neuromuscular dysfunction was graded from -8 (paralysis) to 0 (normal abduction). Therapeutic modalities ranged from conservative treatment (occlusion, prism correction), botulinum toxin chemodenervation and surgical treatment: medial rectus recession + lateral rectus resection, in cases of paresis, and transposition procedures (Hummelscheim and full tendon transfer) in cases of sixth nerve palsy. Functional therapeutic success was defined as absence of diplopia in primary position, with or without prism correction, and surgical success was considered obtaining orthoptic alignment in primary position or a small residual deviation (under 10 PD). 51 patients had unilateral dysfunction, and 9 patients had bilateral VI-th nerve dysfunction. 8 patients had associated fourth or seventh cranial nerves palsy. The most common etiology was traumatic, followed by tumor and vascular causes. There were 18 cases of spontaneous remission, partial or complete (4-8 months after the onset), and 6 cases enhanced by botulinum toxin chemodenervation. 17 paretic eyes underwent surgery, showing a very good outcome, with restoration of binocular single vision. The procedure of choice was recession of medial rectus muscle, combined with resection of lateral rectus muscle. All patients with sixth nerve palsy underwent surgery, except one old female patient, who refused surgery. Hummelscheim procedure was applied in 19 cases, and full tendon transfer in 6 cases. In 13 cases partial results were obtained, who needed further prismatic correction or reintervention. In 12 cases the outcome was very good, with restoration of binocular single vision, without prismatic correction. Therapeutic success in sixth nerve palsy depends on accurate assessment of neuromuscular dysfunction and appropriate choice of therapeutic modality for each case. Interdisciplinary collaboration is mandatory for correct etiologic diagnosis of sixth nerve palsy.

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“…Immediate treatment includes occupying a horizontal position, analgesics, oral and intravenous fluid therapy to increase CSF production, and caffeine to produce vasoconstriction in dilated brain vessels or EBP. 25,44,[63][64][65] In a preventive manner, Arcand proposed early EBP application, during the first 24 hours, to restrict the abducens nerve from compression and stretching. 24,27,30 Epidural blood patch is most effective for treating PDPH (93% effectiveness), but it has not been demonstrated to be an efficacious treatment for EOMP.…”

Section: Resultsmentioning

confidence: 99%

Ocular Motor Palsy After Spinal Puncture

del-Río-Vellosillo

García-Medina

Pinazo-Durán

et al. 2017

Regional Anesthesia and Pain Medicine

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Ocular motor palsy is a rare but alarming complication of subarachnoid puncture. In order to better understand this condition, a literature search was performed in English of PubMed articles for cranial nerves III, IV, and VI palsies after spinal puncture. Sixty-five articles (dated 1930-2015) were identified, and 114 cases were obtained for analysis. Subarachnoid anesthesia was the most frequent cause (45.6%), with a higher incidence for females than males. The age of patients was 40.24 ± 13.35 years (age range, 6-71 years). The sixth cranial nerve was the most commonly involved (92.1%), with higher frequency in the right eye. Palsy onset started 7.30 ± 4.09 days after puncture. Duration in reversible cases was 80.10 ± 80.67 days. Paresia was permanent in 13 patients, but only 2 patients required extraocular muscle surgery. Treatments included the horizontal position along with analgesics, fluid therapy, and corticosteroids. The usefulness of blood patch remains controversial. It is important for anesthesiologists and other physicians to recognize the cardinal features of this process to ensure early diagnosis, avoid unnecessary tests, and guide appropriate treatment.

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Spontaneous recovery rates for unilateral sixth nerve palsies

Cited by 54 publications

References 7 publications

Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy

Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy

Therapeutic results in sixth nerve palsy

Ocular Motor Palsy After Spinal Puncture

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