Document Detail

Clinical Course and Characteristics of Acute Presentation of Fourth Nerve Paresis.
MedLine Citation:
PMID:  22800797     Owner:  NLM     Status:  Publisher    
PURPOSE:Many cases of acute-onset cranial nerve paresis have benign etiologies such as microvascular occlusion. Most will resolve completely and neuroimaging is usually unnecessary. Few reports exist on acute fourth nerve paresis. METHODS:A retrospective review was conducted of all patients presenting with diplopia to the emergency department for 1 year caused by isolated fourth cranial nerve paresis from any cause including trauma. RESULTS:Thirty-two patients met the criteria, 26 (81%) males and 6 (19%) females, with an average age of 59.5 years (range: 14 to 80 years). Eighteen (56%) had a microvascular etiology with diabetes mellitus, hypertension, or both; 6 were already taking medication. Six (19%) had decompensating fourth nerve paresis (2 had hypertension and 1 had recent head trauma). Closed head trauma accounted for 2 patients, migraine and herpes zoster virus accounted for one each, and 4 remained unknown. Nineteen patients (59%) were prescribed prisms and 2 patients were given occlusion. Diplopia resolved without treatment in 23 patients (72%) within 2 weeks to 10 months, but 89% of patients with microvascular etiology resolved spontaneously. Three patients continued with prisms, one patient underwent surgery. CONCLUSION:The prognosis for complete and spontaneous resolution of microvascular fourth nerve paresis was excellent, with 89% completely resolved within 10 months.
Ayman Khaier; Emma Dawson; John Lee
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-17
Journal Detail:
Title:  Journal of pediatric ophthalmology and strabismus     Volume:  -     ISSN:  1938-2405     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7901143     Medline TA:  J Pediatr Ophthalmol Strabismus     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-4     Citation Subset:  -    
Copyright Information:
Copyright 2012, SLACK Incorporated.
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