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Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies
International Journal of Ophthalmology & Visual Science
Volume 4, Issue 1, March 2019, Pages: 24-29
Received: Apr. 28, 2019; Accepted: May 30, 2019; Published: Jun. 11, 2019
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Tal Paz, Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel
Niv Levy, Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel
Hana Leiba, Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel; Hadassah and Hebrew University Medical School, Jerusalem, Israel
Daniel Rappoport, Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel; Hadassah and Hebrew University Medical School, Jerusalem, Israel
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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.
Neuroimaging, Magnetic Resonance Imaging (MRI), Cranial Nerve, Palsy, Acute, Isolated
To cite this article
Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport, Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies, International Journal of Ophthalmology & Visual Science. Vol. 4, No. 1, 2019, pp. 24-29. doi: 10.11648/j.ijovs.20190401.15
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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