目的:确定Ramathibodi医院孤立性第四颅神经麻痹的病因,泰国。
方法:2009年1月1日至2020年7月31日在Ramathibodi医院诊断为孤立性第四神经麻痹的患者,被包括在这个回顾展中,观察案例系列。患者的人口统计数据,介绍时的年龄,记录孤立性第四神经麻痹的病因和神经影像学结果(如有指示).
结果:我们确定了154例单侧和4例双侧孤立性第四神经麻痹。演示时的平均年龄为38.89±25.71岁。单侧病例多为先天性(57.79%),微血管病变(27.92%),颅内肿瘤(8.44%)和其他病因。闭合性颅脑损伤是双侧病例中最常见的病因(75%),其次是破裂的动静脉畸形(25%)。43例(48.84%)第四神经麻痹微血管病变患者中有21例接受了神经影像学检查,根据正常的发现,所有患者的症状在症状出现后6个月内缓解。
结论:在我们的系列中,大多数孤立的第四神经麻痹病例是先天性的,其次是微血管病变和颅内肿瘤,在许多研究中。在微血管病变的情况下,所有病例的临床体征和症状在6个月内解决:观察充分,不需要神经成像。然而,在非典型表现的情况下,应考虑神经影像学检查,比如头痛,眶周疼痛,或者如果进展迅速或没有恢复。
OBJECTIVE: To identify the etiologies of isolated fourth cranial nerve palsy in Ramathibodi hospital, Thailand.
METHODS: Patients diagnosed with isolated fourth nerve palsy from January 1, 2009, through July 31, 2020 in Ramathibodi Hospital, were included in this retrospective, observational case series. The demographic data of patients, age at presentation, the etiologies of isolated fourth nerve palsy and neuroimaging results (if indicated) were recorded.
RESULTS: We identified 154 unilateral and 4 bilateral cases of isolated fourth nerve palsy. Mean age at presentation was 38.89 ± 25.71 years old. Most of the unilateral cases were congenital (57.79%), with microvasculopathy (27.92%), intracranial neoplasm (8.44%) and other etiologies. Trauma with closed head injury was the most common etiology of bilateral cases (75%), followed by ruptured arteriovenous malformation (25%). Twenty-one of the 43 (48.84%) patients with microvasculopathy fourth nerve palsy underwent neuroimaging, with normal findings, and all patients\' symptoms resolved within 6 months of symptom onset.
CONCLUSIONS: In our series, most of the isolated fourth nerve palsy cases were congenital, followed in frequency by microvasculopathy and intracranial tumor, as in many studies. In cases of microvasculopathy, the clinical signs and symptoms resolved within 6 months in all cases: observation was sufficient, with no necessity for neuroimaging. However, neuroimaging should be considered in cases with atypical presentations, such as headache, periorbital pain, or if there is rapid progression or no recovery.