Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile

Abstract

Purpose: The aim of this study was to describe epidemiological and clinical characteristics of pediatric ocular motor cranial nerve palsy. Methods: This was a retrospective record-based study, carried out at a tertiary eye care hospital in India, between January 2011 and January 2015 and included patients up to 16 years of age at the time of presentation, diagnosed with third, fourth, sixth nerve palsy or a combination of these with other cranial nerve palsy. Data analyzed included demographic details, etiologies, presence or absence of amblyopia, relevant investigations, and management. Results: A total of 90 cases were included in the study. Eighty patients (88.88%) presented with isolated nerve palsy. Forty-three patients (47.77%) had congenital nerve palsy. The most common nerve involved was third ( n = 35, 38.88%) followed by sixth ( n = 23, 25.55%) and fourth nerve ( n = 22, 24.44%). Most common cause of third and fourth cranial nerve palsy was congenital ( n = 18, 51.42% and n = 17, 77.30%, respectively), while it was trauma for the sixth nerve ( n = 7, 30.40%). Amblyopia was most frequently associated with third cranial nerve palsy ( n = 27, 77.14%). The radio-imaging yield was maximum ( n = 7, 70%) for combined cranial nerve palsy. Overall 44 (48.88%) patients were managed conservatively, while 46 (51.11%) patients needed squint with or without ptosis surgery. Conclusion: The most common ocular motor cranial nerve involved in the pediatric population was the third cranial nerve, and it was found to be the most amblyogenic in this age group. The neuroimaging yield was maximum for combined cranial nerve palsy. The most common conservatively managed nerve palsy in this study group was the fourth nerve palsy.

Isolated medial rectus hematoma following blunt trauma-a novel case report

“…Trauma is the most common cause of isolated 6th nerve palsy in children, with skull base fractures being the most frequent pathology. 8 In our case, skull base or caudal fractures and intracranial hemorrhage were ruled out by neurological examination and cranial imaging upon presentation to the emergency department.…”

“…Coronal sections for vertical rectus hematomas and axial sections horizontal rectus should be especially evaluated. 1,8 The CT scan revealed distinctly demarcated, irregular coarse densities within the medial rectus muscle, with no pathological findings observed in the adjacent orbital tissues. In patients with isolated rectus muscle hematoma treated conservatively, gradual symptom improvement may confirm the diagnosis, while rapid worsening may necessitate reevaluation.…”