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Multicenter Study
. 2011 Jul;25(7):881-7.
doi: 10.1038/eye.2011.78. Epub 2011 Apr 8.

Prevalence of ocular motor cranial nerve palsy and associations following stroke

F Rowe  1 ; VIS group UK
Collaborators, Affiliations
Multicenter Study

Prevalence of ocular motor cranial nerve palsy and associations following stroke

F Rowe et al. Eye (Lond). 2011 Jul.

Abstract

Aim: Occurrence of ocular motor cranial nerve palsies (OMCNP), following stroke, has not been reported in relation to the type of OMCNP seen and in relation to brain area affected by stroke. The aim of this study was to identify all patients referred with suspected visual impairment to establish the presence and type of OMCNP.

Methods: Prospective, observation study with standardised referral and assessment forms across 20 sites. Visual assessment included visual acuity measurement, visual field assessment, ocular alignment, and movement and visual inattention assessment. Multicentre ethics approval and informed patient consent was obtained.

Results: In total, 915 patients were recruited with mean age of 69.18 years (SD 14.19). Altogether, 498 patients (54%) were diagnosed with ocular motility abnormalities. Of these, 89 patients (18%) had OMCNP. Unilateral third nerve palsy was present in 23 patients (26%), fourth nerve palsy in 14 patients (16%), and sixth nerve palsy in 52 patients (58%). Out of these, 44 patients had isolated OMCNP and 45 had OMCNP combined with other ocular motility abnormalities. Location of stroke was reported mainly in cerebellum, brain stem, thalamus, and internal and external capsules. Treatment was provided for each case including prisms, occlusion, typoscope, scanning exercises, and refraction.

Conclusions: OMCNP account for 18% of eye movement abnormalities in this stroke sub-population. Sixth CNP was most common, followed by third and fourth CNP. Half were isolated and half combined with other eye movement abnormality. Most were treated with prisms or occlusion. The reported brain area affected by stroke was typically the cerebellum, brain stem, and diencephalic structures.

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Figures

Figure 1
Figure 1
Location of stroke. The most usual area for location of stroke lesion causing cranial nerve palsy was the brainstem or cerebellum.
Figure 2
Figure 2
Visual symptoms associated with cranial nerve palsies. Most common visual symptoms included diplopia and blurred vision.
Figure 3
Figure 3
General signs and symptoms. Aphasia and haemiplegia were the most common general signs and symptoms.
Figure 4
Figure 4
Ocular motility disorders associated with cranial nerve palsy.
Figure 5
Figure 5
Strabismus types associated with cranial nerve palsy. Esotropia was more prevalent in sixth nerve palsy.
See this image and copyright information in PMC

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