Clinical Profile of Oculomotor Nerve Palsy

Introduction: Oculomotor nerve palsy in adults can be caused by various causes like microvascular ischemia, post trauma, orbital inflammation, and tumors. The presenting clinical features and neuroimaging aid in diagnosis and management. Aim: The aim was to study the clinical presentation, etiology, and prognosis of oculomotor nerve palsy. Materials and Methods: A prospective study of 30 cases of third cranial nerve palsy was carried out from September 2012 to April 2014 in our Institute. Relevant history was elicited. Clinical examination was performed which included vision acuity testing, extraocular movement assessment, Hess charting for diplopia, eyelid examination, pupillary reaction, and posterior segment evaluation. Details of various etiologies, pupillary involvement, and recovery were documented and analyzed. In all cases, neuroimaging (computed tomography/magnetic resonance imaging brain) was done. Results: Total 30 cases of oculomotor nerve were studied. 21 were males and 9 were females. The age group ranged from 20 to 75 years. 28 patients had unilateral involvement and 2 had bilateral involvement. Follow-up period ranged from 4 months to 11/2years. Microvascular ischemia accounted for 10 cases, post trauma in 16 cases, idiopathic orbital inflammatory disease in two cases, neurotuberculosis in one case and in one case no specific etiology could be identified. Pupil involvement was seen in 17 cases. Complete recovery was seen in 16 cases and partial recovery in 12 cases. In patients with pupil involvement, 7 had complete recovery. In patients with pupil sparing third nerve palsy, 9 had complete recovery. Conclusion: In our Institute, the most common causes of 3rd nerve palsy were trauma and microvascular ischemia. Microvascular ischemic patients had a better prognosis.