Stroke risk among adult patients with third, fourth or sixth cranial nerve palsy: a Nationwide Cohort Study

Rim, Tyler Hyungtaek; Han, Jinu; Choi, Yoon Seong; Lee, Taekjune; Kim, Sung Soo

doi:10.1111/aos.13488

Cited by 14 publications

(19 citation statements)

References 26 publications

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“…The incidence of ophthalmoplegia in patients with diabetes has been reported to be 0.4% in Caucasian diabetic patients, which is lower than the reported rate of 0.56% among Japanese diabetic patients . In a previous nationwide cohort study in South Korea on 466 patients with third, fourth and sixth CN palsy, 300 patients (64%) had pre‐existing diabetes, and the incidence of stroke was higher in diabetics with than without ocular motor nerve palsy (8.2% vs 3.0%, respectively) . However, due to the small number of patients in that study, the complex effect of both diabetes and ocular motor CN palsies on the risk of ischemic stroke was not thoroughly investigated.…”

Section: Discussionmentioning

confidence: 85%

“…31 In a previous nationwide cohort study in South Korea on 466 patients with third, fourth and sixth CN palsy, 300 patients (64%) had pre-existing diabetes, and the incidence of stroke was higher in diabetics with than without ocular motor nerve palsy (8.2% vs 3.0%, respectively). 4 However, due to the small number of patients in that study, the complex effect of both diabetes and ocular motor CN palsies on the risk of ischemic stroke was not thoroughly investigated. In the present study with our large diabetes mellitus registry cohort, the prevalence of ocular motor CN palsies in patients with T2D was 0.16%.…”

Section: Nhis-nscmentioning

confidence: 97%

“…Diabetes is regarded as an independent risk factor for acute stroke resulting from both macro‐ and microvascular complications, and patients with diabetes are more likely to die or be severely disabled after stroke than non‐diabetic patients . Meanwhile, an association has also been reported between isolated third, fourth, and sixth cranial nerve (CN) palsies and ischemic stroke, suggesting ocular motor nerve palsy as an unrecognized risk factor for ischemic stroke . The pathophysiologic mechanism underlying this association is postulated to involve arteriosclerotic conditions such as hypertension, hyperlipidemia, and diabetes, which contribute to large vessel diseases in addition to microvascular ischemia .…”

Section: Introductionmentioning

confidence: 99%

“…2 Meanwhile, an association has also been reported between isolated third, fourth, and sixth cranial nerve (CN) palsies and ischemic stroke, suggesting ocular motor nerve palsy as an unrecognized risk factor for ischemic stroke. [3][4][5] The pathophysiologic mechanism underlying this association is postulated to involve arteriosclerotic conditions such as hypertension, hyperlipidemia, and diabetes, which contribute to large vessel diseases in addition to microvascular ischemia. 3 However, whether isolated ocular motor nerve palsy is an independent risk factor for ischemic stroke in the presence of these common cardiovascular risk factors is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

Park

Yang

Byun

et al. 2018

Journal of Diabetes

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Background The aim of this study was to define the risk of ischemic stroke among newly diagnosed type 2 diabetes (T2D) patients who developed ocular motor cranial nerve (CN) palsies. Methods From the National Health Insurance Service – National Sample Cohort database (2002‐2013) of a random sample of 1 025 340 Koreans, patients with newly diagnosed T2D aged ≥20 years were included in the study. The incidence of ocular motor CN palsies was identified using diagnostic codes for third, fourth, and sixth CN palsies. To determine the effect of incident ocular motor CN palsy on subsequent ischemic stroke, covariate Cox regression was used (Model 1 included only ocular motor CN palsy as a time‐varying covariate; Model 2 included ocular motor CN palsy and demographic information; Model 3 included all variables in Model 2 as well as comorbidity, concomitant medication, and the Charlson comorbidity index score). Results Of 45 820 T2D patients, 75 developed ocular motor CN palsy and 1411 had ischemic stroke. Four patients experienced ischemic stroke after the development of ocular motor CN palsy. Incident ocular motor CN palsy was associated with the subsequent risk of ischemic stroke in Models 1, 2 and 3 (hazard ratios [95% confidence intervals] 3.74 [1.40‐9.98], 3.33 [1.25‐8.89], and 2.96 [1.11‐7.92], respectively). Male sex, older age, and lower income were associated with an increased risk of ischemic stroke. Among confounders, hypertension, atrial fibrillation, and congestive heart failure were associated with the risk of ischemic stroke. Conclusions Physicians should pay more attention to manageable risk factors of ischemic stroke when diabetic patients suffer from ocular motor CN palsies.

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Section: Discussionmentioning

confidence: 85%

Section: Nhis-nscmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

Park

Yang

Byun

et al. 2018

Journal of Diabetes

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show abstract

“…[ 5 ] There have been two reports suggesting that ocular motor cranial nerve (CN) palsy may be an unrecognized risk factor of stroke. [ 5 , 6 ] However, whether the event of isolated ocular motor CN palsy is an independent risk factor of stroke or not is still unclear. In fact, the compound impact of ocular motor CN palsy on the risk of stroke has not been investigated in a very large scale.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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PurposeTo determine whether ocular motor cranial nerve (CN) palsy raises the risk of subsequent stroke in the general population.MethodsWe investigated the association between ocular motor CN palsy and occurrence of stroke using the National Health Insurance Service-National Sample Cohort database from 2002 to 2013. We included individuals aged ≥ 20 years on January 1st, 2004, and excluded those having any paralytic strabismus, disorders in binocular movement, diplopia and any cerebrovascular diseases before entering the cohort. Incident ocular motor CN palsy was identified by diagnostic codes for third, fourth, and sixth nerve palsies. To determine the effect of incident ocular motor CN palsy on the occurrence of subsequent stroke, we used time-varying covariate Cox regression models. Model 1 included only incident third, fourth, and sixth nerve palsies as a time-varying covariate. Model 2 included Model 1 and defined demographic information. Model 3 included Model 2, comorbidity, co-medication, and the Charlson index score.ResultsAmong 727,689 individuals in the cohort, 1,633 patients developed ocular motor CN palsy and 17,657 patients suffered stroke. Cox regression models showed that development of ocular motor CN palsy was associated with an increased risk of subsequent stroke (hazard ratio [HR] = 4.65; 95% confidence intervals [CIs], 3.74–5.80 in Model 1), and the results were consistent even after adjusting for demographic factors and confounders in Model 2 and 3. Men, older age, and individuals not living in Seoul/Incheon area were associated with an increased risk of stroke, while individuals with higher income were associated with decreased risk of stroke in both Model 2 and 3. Sensitivity analyses using propensity score-based matching produced similar results in all three Models (HR = 1.95; 95% CI, 1.55–2.46 in Model 1, HR = 1.91; 95% CI, 1.52–2.41 in Model 2, and HR = 1.63; 95% CI, 1.29–2.06 in Model 3).ConclusionsThe occurrence of ocular motor CN palsy is a significant risk factor of subsequent stroke even after adjusting for demographic factors and confounders in the general population. Physicians may need to educate patients with ocular motor CN palsy regarding the higher risk of future stroke.

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Diplopia, Third Nerve Palsies, and Sixth Nerve Palsies

Rucker¹,

Calix²

2021

Emergency Neurology

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Stroke risk among adult patients with third, fourth or sixth cranial nerve palsy: a Nationwide Cohort Study

Abstract: Patients in the NP cohort were more likely to have a stroke than those in the matched control cohort; the increased risk was both time- and cranial nerve-dependent.

Cited by 14 publications

References 26 publications

Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

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

Diplopia, Third Nerve Palsies, and Sixth Nerve Palsies

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