Causes and Treatment Outcomes of Third, Fourth and Sixth Nerve Palsy

Pennapa Soontrapa

Purpose: To evaluate the causes and the results of treatment outcomes of third, fourth and sixth nerve palsy

Methods: Medical records of 157 cases with extraocular muscle palsy from third, fourth or sixth nerve palsy between January 1995 and December 2009 were reviewed.

Results: One hundred fifty seven cases from 600 cases were included in the study. Seventy six cases were male and 81 cases were female. The subjects aged from 1 day to 73 years old. Twenty one cases (13.4%) were congenital extraocular muscle palsy and 136 cases (86.6%) were acquired causes. The most common cranial nerve palsy was sixth nerve 63 cases (40.1%). Others were third nerve 49 cases (31.2%) and fourth nerve 36 cases (22.9%). Of 157 cases,the causes were trauma 41 cases (26.1%), vascular cause 39 cases (24.8%) and congenital cause 21 cases (13.4%) . The common causes of isolated third nerve palsy (n=49) were vascular (11 cases) and trauma (20cases). The most common cause of isolated fourth nerve palsy was congenital 16 cases (44.4%) and isolated sixth nerve palsy was vascular 22 cases (35%). Cranial nerve palsy patients from vascular cause spontaneously improved 32 of 39 cases (82.1%) in 6 months. All patients (21 cases) from congenital cranial nerve palsy had extraocular muscle surgery and 17 cases (80.9%) were successful.

Conclusions: Sixth nerve was the most common cranial nerve palsy. Vascular cause was common in isolated sixth nerve palsy and isolated third nerve palsy. Most cases from vascular cause spontaneously improved in 6 months.