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

Tal Paz, N. Levy, H. Leiba, Daniel A. Rappoport
{"title":"Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies","authors":"Tal Paz, N. Levy, H. Leiba, Daniel A. Rappoport","doi":"10.11648/J.IJOVS.20190401.15","DOIUrl":null,"url":null,"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.","PeriodicalId":14184,"journal":{"name":"International Journal of Ophthalmology & Visual Science","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Ophthalmology & Visual Science","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.11648/J.IJOVS.20190401.15","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1

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.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
早期神经影像学在治疗急性孤立性眼运动神经麻痹中的作用
背景:早期神经影像学在老年血管病变急性孤立性眼运动神经麻痹患者中的作用仍存在争议。我们想要证明神经科医生和眼科医生之间的方法差异,并检查早期神经影像学在治疗急性眼运动单神经病变中的作用。方法:回顾性图表复习。患者年龄≥50岁,有血管病变危险因素,表现为急性孤立性第三、第四或第六脑神经麻痹。我们比较了神经内科医生和眼科医生在初次就诊时的早期神经影像学转诊率,并评估了单个医疗中心中早期神经影像学后最终诊断发生改变的病例比例。结果:共纳入54例患者。排除第三神经麻痹患者后,与眼科医生相比,最初就诊于神经科医生的患者进行早期神经影像学检查的比例明显更高(29/38的患者进行了早期神经影像学检查,其中20例由神经科医生进行,9例由眼科医生进行,p<0.001)。在38例表现为第四或第六神经麻痹的患者中,只有4/38(10%)被发现有微血管缺血以外的原因,只有2/29(7%)的患者被发现有病因病变。结论:对于急性孤立性第4或第6神经麻痹并伴有血管病变危险因素的老年患者,应权衡是否进行早期神经影像学检查。全面的病史记录和谨慎的体格检查对于识别风险较大的患者非常重要,因此需要早期进行神经影像学检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Prevalence of Amblyogenic Risk Factors in Congenital Nasolacrimal Duct Obstruction in a Developing Country Macular Hole Following Retained Subfoveal PFCL Treatment Burden and Quality of Life of Patients with Neovascular Age-Related Macular Degeneration (nAMD) and Their Caregivers—A Review Internal Audit as a Quality Assurance Tool to Ensure Staff and Patient Safety During COVID-19 Pandemic A Case History of Internal Ophthalmomyiasis, a Rare and Devastating Disease
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1