Causes and Treatment Outcomes of Third, Fourth and Sixth Cranial Nerve Palsy
Thammanoon Surachatkumtonekul MD*, Pennapa Soontrapa MD*, Suchada Kampanartsanyakorn MD*, Dhaivadee Dulayajinda MD*
Affiliation : * Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
Objective : To evaluate the causes and the treatment outcomes of third, fourth and sixth cranial nerve palsy.
Material and Method: Medical records of 157 cases with extra-ocular muscle palsy from third, fourth or sixth cranial nerve
palsy between January 1995 and December 2009 were reviewed. Demographic data, age, causes of extra-ocular muscle
palsy and treatment outcomes were record and analyzed. The patients who were followed-up less than 6 months, myasthenia
gravis and extra-ocular muscles fibrosis were excluded from the present study.
Results : One hundred and fifty-seven cases from 600 cases were included in the present study. The most common cranial
nerve palsy was the sixth cranial nerve with 63 cases (40.1%). Of 157 cases, the causes were trauma 41 cases (26.1%),
microvascular occlusion cause 34 cases (21.7%) and congenital cause 21 cases (13.4%). Cranial nerve palsy patients from
microvascular occlusion cause spontaneously improved 25 of 34 cases (73.5%) in 6 months. All patients (21 cases) from
congenital cranial nerve palsy had extra-ocular muscle surgery and 17 patients (80.9%) were successful.
Conclusion : Sixth cranial nerve palsy was the most common cranial nerve palsy. Most patients with cranial nerve palsy from
vascular cause spontaneously improved in 6 months. Congenital cranial nerve palsy patients need extra-ocular muscle
surgery and most cases were successful
Keywords : Cranial nerve, Palsy, Diplopia, Strabismus, Extra-ocular muscle
