Etiological distribution of isolated oculomotor nerve palsy: analysis of 633 patients and literature review

Abstract

Background and purposeThe etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of isolated oculomotor nerve palsy by recruiting patients from all departments in a referral‐based university hospital.MethodsThe medical records of 672 patients who had a confirmed diagnosis of isolated oculomotor nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020 were reviewed. A proportion of the etiology of isolated oculomotor nerve palsy was also compared with that of patients pooled from the previous studies that were searched on PubMed in May 2022.ResultsThe most common etiology was microvascular (n = 168, 26.5%), followed by vascular anomalies (n = 110, 17.4%), neoplastic (n = 86, 13.6%), inflammatory (n = 79, 12.5%), idiopathic (n = 60, 9.5%) and traumatic (n = 53, 8.4%). Neurologists were mainly involved in the management of microvascular and inflammatory oculomotor nerve palsies whilst ophthalmologists mainly participated in the care of idiopathic, neoplastic and traumatic palsies. Neurosurgeons mostly took care of oculomotor nerve palsy due to vascular anomalies.ConclusionsThe proportion of etiologies of isolated oculomotor nerve palsy may differ according to the specialties involved in the management. The results of previous studies on the etiological distribution of isolated oculomotor nerve palsy should be interpreted with this consideration.

Oculomotor Nerve Palsy—Etiologies, Symptoms and Diagnosis: A Systematic Review with Meta-Analysis

“…Age distribution, sex, and laterality are summarized in Table 2 . Risk of bias assessment depicted 14 studies with low risk [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ] and 10 studies with moderate risk [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Neoplasms represent a critical etiology for OMNP, as dysfunction of the OMN can often serve as the earliest clinical sign of a brain tumor [ 17 ]. The most common neoplasms identified as causes include meningiomas ( Figure 13 ) [ 23 ] and pituitary adenomas, which are frequently apoplectic and metastatic lesions from solid tumors [ 21 ]. Additional neoplastic etiologies documented in the literature include gliomas, nasopharyngeal carcinomas [ 25 ], craniopharyngiomas, and nerve-specific lesions such as oculomotor nerve schwannomas [ 21 ].…”

“… Forest ( A1 , B1 , C1 ) and DOI ( A2 , B2 , C2 ) plots for the oculomotor nerve palsy and the three most common etiologies—vascular ( A1 , A2 ), unknown ( B1 , B2 ), and other ( C1 , C2 ) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. …”

Oculomotor Nerve Palsy—Etiologies, Symptoms and Diagnosis: A Systematic Review with Meta-Analysis

“…Age distribution, sex, and laterality are summarized in Table 2 . Risk of bias assessment depicted 14 studies with low risk [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ] and 10 studies with moderate risk [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Neoplasms represent a critical etiology for OMNP, as dysfunction of the OMN can often serve as the earliest clinical sign of a brain tumor [ 17 ]. The most common neoplasms identified as causes include meningiomas ( Figure 13 ) [ 23 ] and pituitary adenomas, which are frequently apoplectic and metastatic lesions from solid tumors [ 21 ]. Additional neoplastic etiologies documented in the literature include gliomas, nasopharyngeal carcinomas [ 25 ], craniopharyngiomas, and nerve-specific lesions such as oculomotor nerve schwannomas [ 21 ].…”

“… Forest ( A1 , B1 , C1 ) and DOI ( A2 , B2 , C2 ) plots for the oculomotor nerve palsy and the three most common etiologies—vascular ( A1 , A2 ), unknown ( B1 , B2 ), and other ( C1 , C2 ) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. …”

Diagnostic Value of Pupil Involvement and Yield of Vascular Imaging in Isolated Third Cranial Nerve Palsy: A 10-Year Retrospective Study

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Development of a Flexible Electrode for Electrical Stimulation of Rabbit Extraocular Muscle

“…Ocular motor nerve palsies are clinically important because they are most commonly associated with microvascular ischemia [ 9 – 11 ], and could be a significant risk factor of stroke [ 12 ]. Furthermore, ocular motor nerve palsies can cause diplopia and loss of stereopsis, which could be debilitating and severely impact the quality of life [ 9 ].…”

Oculomotor Nerve Palsy—Etiologies, Symptoms and Diagnosis: A Systematic Review with Meta-Analysis

“…Age distribution, sex, and laterality are summarized in Table 2 . Risk of bias assessment depicted 14 studies with low risk [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ] and 10 studies with moderate risk [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Neoplasms represent a critical etiology for OMNP, as dysfunction of the OMN can often serve as the earliest clinical sign of a brain tumor [ 17 ]. The most common neoplasms identified as causes include meningiomas ( Figure 13 ) [ 23 ] and pituitary adenomas, which are frequently apoplectic and metastatic lesions from solid tumors [ 21 ]. Additional neoplastic etiologies documented in the literature include gliomas, nasopharyngeal carcinomas [ 25 ], craniopharyngiomas, and nerve-specific lesions such as oculomotor nerve schwannomas [ 21 ].…”

“… Forest ( A1 , B1 , C1 ) and DOI ( A2 , B2 , C2 ) plots for the oculomotor nerve palsy and the three most common etiologies—vascular ( A1 , A2 ), unknown ( B1 , B2 ), and other ( C1 , C2 ) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. …”

Diagnostic Value of Pupil Involvement and Yield of Vascular Imaging in Isolated Third Cranial Nerve Palsy: A 10-Year Retrospective Study

“……”

Development of a Flexible Electrode for Electrical Stimulation of Rabbit Extraocular Muscle

“…Ocular motor nerve palsies are clinically important because they are most commonly associated with microvascular ischemia [ 9 – 11 ], and could be a significant risk factor of stroke [ 12 ]. Furthermore, ocular motor nerve palsies can cause diplopia and loss of stereopsis, which could be debilitating and severely impact the quality of life [ 9 ].…”

Oculomotor Nerve Palsy—Etiologies, Symptoms and Diagnosis: A Systematic Review with Meta-Analysis

“…Age distribution, sex, and laterality are summarized in Table 2 . Risk of bias assessment depicted 14 studies with low risk [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ] and 10 studies with moderate risk [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Neoplasms represent a critical etiology for OMNP, as dysfunction of the OMN can often serve as the earliest clinical sign of a brain tumor [ 17 ]. The most common neoplasms identified as causes include meningiomas ( Figure 13 ) [ 23 ] and pituitary adenomas, which are frequently apoplectic and metastatic lesions from solid tumors [ 21 ]. Additional neoplastic etiologies documented in the literature include gliomas, nasopharyngeal carcinomas [ 25 ], craniopharyngiomas, and nerve-specific lesions such as oculomotor nerve schwannomas [ 21 ].…”

“… Forest ( A1 , B1 , C1 ) and DOI ( A2 , B2 , C2 ) plots for the oculomotor nerve palsy and the three most common etiologies—vascular ( A1 , A2 ), unknown ( B1 , B2 ), and other ( C1 , C2 ) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. …”

Diagnostic Value of Pupil Involvement and Yield of Vascular Imaging in Isolated Third Cranial Nerve Palsy: A 10-Year Retrospective Study

“……”

Development of a Flexible Electrode for Electrical Stimulation of Rabbit Extraocular Muscle

“…Ocular motor nerve palsies are clinically important because they are most commonly associated with microvascular ischemia [ 9 – 11 ], and could be a significant risk factor of stroke [ 12 ]. Furthermore, ocular motor nerve palsies can cause diplopia and loss of stereopsis, which could be debilitating and severely impact the quality of life [ 9 ].…”