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J. L. Chua, E. Chee, S. Tow, Singapore Neuro-Ophthalmology Study Group, J. F. Cullen, E. Fu, K. Y. Goh, S. A. Lim, C. Tan, A. Seah; Ischemic Ocular MotorNnerve Cranial Nerve Palsy in Singapore - A 22-month Epidemiology Review. Invest. Ophthalmol. Vis. Sci. 2007;48(13):950.
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We aim to evaluate the epidemiologic features of ischemic ocular motor cranial nerve palsy in our local population as well as compare our results with those published for Western populations.
All patients with new onset ocular motor cranial nerve palsies seen in the Neuro-Ophthalmology clinic in 4 hospitals between September 2002 and June 2004 were enrolled into the study. Clinical reviews with a standard questionnaire were carried out at regular intervals for two years or until resolution of the nerve palsy occurred. Patients that defaulted on clinic reviews received telephone interviews regarding the status of their symptoms. We excluded patients who were uncontactable. A case was classified as ischemic if the patient either had an acute solitary ocular cranial nerve palsy as well as ischemic risk factor(s), or had multiple ocular cranial nerve palsies with documented radiological evidence of a cerebrovascular accident.
Of the total 173 patients enrolled, an ischemic cause was found in 90 patients, making it the commonest aetiology identified. 71% were males and 90% aged above 50 years. 84 patients had an isolated ocular motor cranial nerve palsy, of which the 6th nerve was the most frequently affected. 24 patients had hypertension only, 22 patients had diabetes only and 36 patients had both hypertension and diabetes. 39 patients had hyperlipidemia, 13 had ischemic heart disease and 13 had history of cerebrovascular accident. 8 patients were active smokers at presentation, whilst 13 were ex-smokers. Of those patients with undiagnosed ischemic risk factors on presentation, 21% were found to have hypertension, 5.2% with diabetes, 53.8%, with cerebrovascular accident and 30.8% with hyperlipidemia. Of the 82 cases that completed follow-up, 78 had completed resolution and 3 had partial resolution of nerve palsy. The mean duration taken for complete resolution was 3.8 months (range: 1 day to 17 months).
Ischemia is the commonest aetiology found in ocular motor cranial nerve palsies seen in Singapore, with the 6th cranial nerve being the most commonly affected. Prognosis for resolution of ischemic ocular motor cranial nerve palsy is excellent. Although the commonest aetiologic group in ocular cranial nerve palsy in the West is undetermined, head trauma is the commonest amongst the identified aetiologies, followed by ischemia.
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