Abstract
Purpose :
To develop a clinical prediction score that can be used to determine whether or not acquired isolated third nerve palsy patients require neuroimaging.
Methods :
A retrospective study was performed. Demographic data and clinical presentations were collected to determine predictive factors favored for brain imaging using multivariate logistic regression analysis. The fitted model for the scoring system was demonstrated with a receiver operating characteristic (ROC) curve.
Results :
Ninety-seven eyes of 96 patients diagnosed with isolated third nerve palsy were included. Forty-one eyes (42.3%) were caused by ischemia, while the other 56 eyes (57.7%) were caused by non-ischemic etiologies, namely aneurysm (n=22), trauma (n=19), tumor (n=4), inflammation (n=5), and others (n=6). Eighty-two eyes (84.5%) underwent neuroimaging due to initially suspected non-ischemic causes. Only 36 (43.9%) revealed concordant diagnoses. The potential clinical predictors to perform a neuroimaging study were age groups of 51-70 years old (adjusted odds ratio [aOR] 2.92, 95% CI 0.95-8.93) and 15-50 years old (aOR 55.7, 95% CI 3.44-903), history of head trauma (aOR 6.54, 95% CI 1.09-39.37), absence of stroke (aOR 12.5, 95% CI 1.03-151.4), and poor pupillary response (aOR 6.32, 95% CI 1.92-20.75). The predictor scores derived from the coefficients of the logistic regression model with an area under the ROC curve of 0.864 for 15-50 years of age, 51-70 years of age, history of head trauma, absence of stroke, and poor pupillary response were 8, 2, 4, 5, and 4 respectively. The optimum cut-point which gave a sensitivity of 96% and specificity of 43.9% was 6.
Conclusions :
Among patients with acquired isolated third nerve palsy, those who are 15-50 years of age or 51-70 years of age with previous head trauma, absence of stroke or poor pupillary reaction or aged >70 years with at least two of the three aforementioned risk factors should be considered for neuroimaging studies. Otherwise the patient should be closely observed to prevent unnecessary imaging.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.