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Isolated Third, Fourth, and Sixth Cranial Nerve Palsies in the Turkish Population: Etiologic Factors and Clinical Course [Turk J Neurol]
Turk J Neurol. 2019; 25(1): 32-35 | DOI: 10.4274/tnd.galenos.2019.29795  

Isolated Third, Fourth, and Sixth Cranial Nerve Palsies in the Turkish Population: Etiologic Factors and Clinical Course

Ayşe İlksen Çolpak1, Hale Batur Çağlayan2
1Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turke
2Gazi University Faculty of Medicine, Department of Neurology, Ankara, Turkey

Objective: To determine the etiologic factors and clinical profile of isolated third, fourth, and sixth nerve palsies in neuro-ophthalmology outpatient clinics of two different reference centers.
Materials and Methods: Retrospective evaluation of medical records from the institutional database.
Results: A total of 127 (78 male, 49 female) patients were analyzed. Forty-five (35.4%) patients had isolated third nerve palsy, 34 (26.8%) had isolated fourth nerve palsy, and 48 (37.8%) patients had isolated sixth nerve palsy. The mean ages were similar; 58.87±13.6, 56.32±16.1, and 54.9±14.4 years, respectively (p=0.4). Diplopia was the main symptom seen in all patients. Twenty-one patients had anisocoria (20 third, 1 fourth). Among patients with anisocoria, 3 patients had final diagnoses of vasculopathy, the rest were diagnosed as having acquired non travmatic palsy with different etiologies such as aneurysm, Tolosa-Hunt syndrome, and carotico-cavernous fistula. The most common etiology for all groups was vasculopathy. Three patients with isolated oculomotor nerve palsy were diagnosed as having Tolosa-Hunt sydnrome despite pupillary sparing. The mean recovery time was similar for all cranial nerve palsies.
Conclusion: Although, the most common etiology of third, fourth, and sixth nerve palsies is vasculopathy, neuroimaging studies are crucial to exclude potentially treatable and dangerous conditions.

Keywords: Diplopia, third nerve palsy, fourth nerve palsy, sixth nerve pals


Ayşe İlksen Çolpak, Hale Batur Çağlayan. Isolated Third, Fourth, and Sixth Cranial Nerve Palsies in the Turkish Population: Etiologic Factors and Clinical Course. Turk J Neurol. 2019; 25(1): 32-35

Corresponding Author: Ayşe İlksen Çolpak, Türkiye


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