The Clinical Study Of Oculomotor Nerve Palsies In 50 Patients

Objectives:To analyze the causes,clinical manifestations,methods of examination,treatment and prognosis of oculomotor nerve palsy.Methods:50 cases with oculomotor nerve palsy were retrospectively analyzed,all these cases were selected from 89 cases with Ophthalmoplegia admitted to the Second Affiliated Hospital of Dalian Medical University during January 2002 to June 2007.All cases underwent CT or MRI scan.35 cases with suspected intracranial aneurysms underwent DSA,10 cases added nerve conduction velocity examination,4 case underwent lumbar puncture. Appropriate treatment was given according to different diagnosis,including controlling blood glucose,nerve nutrition,improving microcirculation, anti- infection,the impact of hormones,aneurysm embolization,surgical clipping of aneurysm,etc.The causes,clinical manifestations,the necessity for early DSA and prognosis were analyzed.Results:1.The main cause of oculomotor nerve palsy was intracranial aneurysm,found in 20(40%) cases in this study,Further analysis showed that majority(80.0 %)aneurysms located in posterior communicating artery.The ischemic stroke of brain stem was found in 8(16%)cases,diabetic oculomotor nerve paralysis in 6(12%)cases,painful ophthalmoplegia in 5(10%)cases.Other rare causes include oculomotor nerve infections in 3 cases,carotid-cavernous fistula,thrombosis of transverse sinus,bacterial meningitis and encephalitis of the brain stem,4(8%)cases could not find the final cause even after varied examinations including DSA,MR,CT and blood glucose etc.2.DSA was underwent in 35 cases suspected with intracranial aneurysms.As a result,aneurysms were found in 20(57.1%)cases.Futher analysis of 15 cases without aneurysms showed brain stem infarction in 5 cases,oculomotor nerve infection in 3 cases,diabetic oculomotor nerve paralysis in 2 cases,painful ophthalmoplegia in 2 cases,and transverse sinus thrombosis in 1 case.Etiology could not be defined in 2 case.3.Subarachnoid hemorrhage was caused by rupture of intracranial aneurysms in 8(40.0%)cases,3(37.5%)cases of which died.4.30% of the cases improved after a certain period of treatment,but the cure rate was only 22%,up to 48% of cases showed no improvement(6% death).Conclusions:1.Many causes can cause oculomotor nerve palsy,some are even life- threatening.Though some causes are not dangerous,but the long-term diplopia also cause great suffering to patients.To achieve early diagnosis,necessary examinations such as DSA,MR,etc.should be perfouned according to the clinical features.2.DSA should be perfouned as soon as possible for patients with highly suspected intracranial aneurysms.Then further relevant examinations should be chosen to clear the cause for patients without aneurysms.3,There was always unfavorable prognosis for oculomotor nerve palsy caused by various reasons ,more clinical data were needed to draw the conclusion concerning the best treatment.