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Matthew M. Kruger, F. Ray Jones; Ethnic Differences In The Presentation And Characteristics Of Oculomotor Nerve Palsy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4896.
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To characterize ten years of third cranial nerve palsies at Parkland Health and Hospital system and to review diagnosis, demographics, type of imaging and prognosis and to compare these variables between Hispanic and non-Hispanic patients as well as to evaluate the watch and wait precept regarding timing of neuroimaging.
Case identification through retrospective chart review of 68 third nerve palsies from the Ophthalmology Clinic at Parkland Hospital from 2000-2009. Data was collected regarding demographics, medical history, type of imaging, diagnosis and prognosis.
100 patients were identified as having a cranial nerve three palsy over the ten-year period. The average age was 50.3 years. 62% were of Hispanic origin. 59% had diabetes and 40% had hypertension. The most common cause was microvascular insult (54%) followed by brain tumors and trauma (16% and 10%). 95% of patients received neuroimaging with 90% within one week. Among patients of Hispanic origin, 62% had a microvascular etiology compared with 38% of non-Hispanic patients (p=0.0011). 40% of patients overall and 36% of the patients with microvascular etiology did not follow-up for more than one week.
All patients with complete pupil sparing lesions over the age of 50 without GCA symptoms or history of cancer could have been watched for resolution before neuroimaging. Hispanic patients are much more likely to have a microvascular etiology than non-Hispanic patients. The watch and wait precept for suspected microvascular etiology may not apply in a patient cohort when poor follow-up is likely.
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