Early progression of ophthalmoplegia in patients with ischemic oculomotor nerve palsies
D. M. Jacobson and S. K. Broste
Department of Neurology, Marshfield (Wis) Clinic, USA.
OBJECTIVE: To describe the frequency and clinical correlates of early
progression of ophthalmoplegia in patients with ischemic oculomotor nerve
palsies. DESIGN: Cohort survey, case series. SETTING: Multispecialty clinic
providing primary, secondary, and tertiary care in central and northern
Wisconsin. PATIENTS: Sixteen patients evaluated within 1 week of the
reported onset of ischemic oculomotor nerve palsy were identified and
followed up prospectively using a standardized ophthalmoplegia grading
scheme. All patients were followed up serially until their ophthalmoplegia
resolved. MAIN OUTCOME MEASURES: Descriptive analysis of the temporal
course of ophthalmoplegia and frequency of progression of deficits.
Comparison between the group that had progression of ophthalmoplegia with
the group that did not for age, hematocrit, cholesterol level, and
adiposity; presence of diabetes, hypertension, hypercholesterolemia, and
coronary artery disease; history of stroke; and tobacco use. RESULTS:
Eleven (69%) of 16 patients had progression of ophthalmoplegia. The median
time between reported onset and peak severity of ophthalmoplegia was 10
days. The only important difference between the progressive and
nonprogressive groups was a shorter time to resolution of ophthalmoplegia
for the nonprogressive group. CONCLUSIONS: Early progression of
ophthalmoplegia occurs often in patients with ischemic oculomotor nerve
palsies. The power to find differences between progressive and
nonprogressive groups was limited by the small number of patients available
for analysis.
