International Journal of Ophthalmology & Visual Science

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Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies

Received: 28 April 2019    Accepted: 30 May 2019    Published: 11 June 2019
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Abstract

Background: The role of early neuroimaging in older vasculopathic patients presenting with acute isolated ocular motor nerve palsy is still being debated. We wanted to demonstrate the approach differences between neurologists and ophthalmologists, and examine the role of early neuroimaging in managing acute ocular motor mononeuropathies. Methods: Retrospective chart review. Patients ≥ 50 years with vasculopathic risk factors, presenting with acute isolated third, fourth or sixth cranial nerve palsies. We compared the rate of early neuroimaging referral between neurologists and ophthalmologists at initial presentation, and assessed the proportion of cases in which the final diagnosis has changed after early neuroimaging, in a single medical center. Results: 54 patients were included. After excluding patients with third nerve palsy, the rate of patients referred to early neuroimaging was significantly greater when initially presented to a neurologist compared with an ophthalmologist (29/38 patients were referred to early neuroimaging, of whom twenty by a neurologist and nine by an ophthalmologist, p<0.001). Out of 38 patients presented with fourth or sixth nerve palsies, only 4/38 (10%) were found to have a cause other than presumed microvascular ischemia, and only 2/29 (7%) patients referred to neuroimaging were found to have a causative lesion. Conclusions: The decision to perform early neuroimaging in older patients with acute isolated 4th or 6th nerve palsies and vasculopathic risk factors could be weighed against observation alone. Thorough history taking and prudent physical examination are important for identifying patients with greater risks, therefore needing early neuroimaging.

DOI 10.11648/j.ijovs.20190401.15
Published in International Journal of Ophthalmology & Visual Science (Volume 4, Issue 1, March 2019)
Page(s) 24-29
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Neuroimaging, Magnetic Resonance Imaging (MRI), Cranial Nerve, Palsy, Acute, Isolated

References
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Author Information
  • Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel

  • Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel

  • Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel; Hadassah and Hebrew University Medical School, Jerusalem, Israel

  • Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel; Hadassah and Hebrew University Medical School, Jerusalem, Israel

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  • APA Style

    Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport. (2019). Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. International Journal of Ophthalmology & Visual Science, 4(1), 24-29. https://doi.org/10.11648/j.ijovs.20190401.15

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    ACS Style

    Tal Paz; Niv Levy; Hana Leiba; Daniel Rappoport. Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. Int. J. Ophthalmol. Vis. Sci. 2019, 4(1), 24-29. doi: 10.11648/j.ijovs.20190401.15

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    AMA Style

    Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport. Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. Int J Ophthalmol Vis Sci. 2019;4(1):24-29. doi: 10.11648/j.ijovs.20190401.15

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  • @article{10.11648/j.ijovs.20190401.15,
      author = {Tal Paz and Niv Levy and Hana Leiba and Daniel Rappoport},
      title = {Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {4},
      number = {1},
      pages = {24-29},
      doi = {10.11648/j.ijovs.20190401.15},
      url = {https://doi.org/10.11648/j.ijovs.20190401.15},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ijovs.20190401.15},
      abstract = {Background: The role of early neuroimaging in older vasculopathic patients presenting with acute isolated ocular motor nerve palsy is still being debated. We wanted to demonstrate the approach differences between neurologists and ophthalmologists, and examine the role of early neuroimaging in managing acute ocular motor mononeuropathies. Methods: Retrospective chart review. Patients ≥ 50 years with vasculopathic risk factors, presenting with acute isolated third, fourth or sixth cranial nerve palsies. We compared the rate of early neuroimaging referral between neurologists and ophthalmologists at initial presentation, and assessed the proportion of cases in which the final diagnosis has changed after early neuroimaging, in a single medical center. Results: 54 patients were included. After excluding patients with third nerve palsy, the rate of patients referred to early neuroimaging was significantly greater when initially presented to a neurologist compared with an ophthalmologist (29/38 patients were referred to early neuroimaging, of whom twenty by a neurologist and nine by an ophthalmologist, pConclusions: The decision to perform early neuroimaging in older patients with acute isolated 4th or 6th nerve palsies and vasculopathic risk factors could be weighed against observation alone. Thorough history taking and prudent physical examination are important for identifying patients with greater risks, therefore needing early neuroimaging.},
     year = {2019}
    }
    

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    T1  - Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies
    AU  - Tal Paz
    AU  - Niv Levy
    AU  - Hana Leiba
    AU  - Daniel Rappoport
    Y1  - 2019/06/11
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    N1  - https://doi.org/10.11648/j.ijovs.20190401.15
    DO  - 10.11648/j.ijovs.20190401.15
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
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    UR  - https://doi.org/10.11648/j.ijovs.20190401.15
    AB  - Background: The role of early neuroimaging in older vasculopathic patients presenting with acute isolated ocular motor nerve palsy is still being debated. We wanted to demonstrate the approach differences between neurologists and ophthalmologists, and examine the role of early neuroimaging in managing acute ocular motor mononeuropathies. Methods: Retrospective chart review. Patients ≥ 50 years with vasculopathic risk factors, presenting with acute isolated third, fourth or sixth cranial nerve palsies. We compared the rate of early neuroimaging referral between neurologists and ophthalmologists at initial presentation, and assessed the proportion of cases in which the final diagnosis has changed after early neuroimaging, in a single medical center. Results: 54 patients were included. After excluding patients with third nerve palsy, the rate of patients referred to early neuroimaging was significantly greater when initially presented to a neurologist compared with an ophthalmologist (29/38 patients were referred to early neuroimaging, of whom twenty by a neurologist and nine by an ophthalmologist, pConclusions: The decision to perform early neuroimaging in older patients with acute isolated 4th or 6th nerve palsies and vasculopathic risk factors could be weighed against observation alone. Thorough history taking and prudent physical examination are important for identifying patients with greater risks, therefore needing early neuroimaging.
    VL  - 4
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