Can we predict recurrence in ocular motor palsies? Clinico-investigational Study of 34 patient
Volume : 2
Issue : 3
Online ISSN : 2581-916X
Print ISSN : 2581-8236
Article First Page : 69
Article End Page : 73
Introduction: Ocular motor nerve palsies are common and disabling. Nearly 25% cases remain undiagnosed. Study of factors which predict recurrence and increase diagnostic yield, is important for prognostic and therapeutic purpose.
Methodology: Prospective study done in the period from Jan 2009 to Dec 2015. Inclusion-Patient presenting with diplopia and/or 3, 4 or 6 nerve palsy. Exclusion-Congenital ocular motor palsy, birth injuries, neuromuscular disorder, myopathies, inherited disorders, brainstem lesions and head trauma. History, examination noted and all patients were followed up for 1 year from enrolment. Investigations included serum biochemistry, ESR, complete blood count, antinuclear antibody (ANA) and CSF in selected patients and Magnetic resonance imaging (MRI) of the brain with thin T1 weighted coronal post gadolinium cuts through the cavernous sinus. Asymmetric thickening of cavernous sinus ipsilateral to nerve palsy is considered pathological.
Results and Conclusion: Total 34 patients studied. Aetiology could be ascertained in 85 %. Single nerve palsy in 20 and multiple nerve palsy was found in 14 patients. Ten patients had a recurrent palsy and 24 had a single episode. Recurrence was significantly associated with cavernous sinus thickening/ pachymeningitis and in higher proportion with multiple cranial nerve palsy as well as ANA positive patients.
Keywords: Ocular motor palsy, Cavernous sinus thickening, Oachymeningitis, Recurrence, Pachymeningitis.
Key Messages: Systematic clinical and investigational approach increases diagnostic certainty in ocular motor palsy Cavernous sinus thickening, pachymeningitis and positive antinuclear antibody are likely to have recurrent ocular motor palsy. Can we predict recurrence in ocular motor palsies? Clinico-investigational Study of 34 patients