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

Tal Paz; Niv Levy; Hana Leiba; Daniel Rappoport

doi:doi:10.11648/j.ijovs.20190401.15

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

Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport

Published in International Journal of Ophthalmology & Visual Science (Volume 4, Issue 1)

Received: 28 April 2019 Accepted: 30 May 2019 Published: 11 June 2019

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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 4^th or 6^th 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.

Published in	International Journal of Ophthalmology & Visual Science (Volume 4, Issue 1)
DOI	10.11648/j.ijovs.20190401.15
Page(s)	24-29
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Neuroimaging, Magnetic Resonance Imaging (MRI), Cranial Nerve, Palsy, Acute, Isolated

References

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APA Style

Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport. (2019). Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. International Journal of Ophthalmology & Visual Science, 4(1), 24-29. https://doi.org/10.11648/j.ijovs.20190401.15

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ACS Style

Tal Paz; Niv Levy; Hana Leiba; Daniel Rappoport. Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. Int. J. Ophthalmol. Vis. Sci. 2019, 4(1), 24-29. doi: 10.11648/j.ijovs.20190401.15

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AMA Style

Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport. Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. Int J Ophthalmol Vis Sci. 2019;4(1):24-29. doi: 10.11648/j.ijovs.20190401.15

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@article{10.11648/j.ijovs.20190401.15,
  author = {Tal Paz and Niv Levy and Hana Leiba and Daniel Rappoport},
  title = {Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {4},
  number = {1},
  pages = {24-29},
  doi = {10.11648/j.ijovs.20190401.15},
  url = {https://doi.org/10.11648/j.ijovs.20190401.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20190401.15},
  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, pConclusions: 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.},
 year = {2019}
}

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TY  - JOUR
T1  - Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies
AU  - Tal Paz
AU  - Niv Levy
AU  - Hana Leiba
AU  - Daniel Rappoport
Y1  - 2019/06/11
PY  - 2019
N1  - https://doi.org/10.11648/j.ijovs.20190401.15
DO  - 10.11648/j.ijovs.20190401.15
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 24
EP  - 29
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20190401.15
AB  - 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, pConclusions: 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.
VL  - 4
IS  - 1
ER  -

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Author Information

Tal Paz

Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel
Niv Levy

Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel
Hana Leiba

Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel
Daniel Rappoport

Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel

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Plain Text BibTeX RIS

APA Style

Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport. (2019). Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. International Journal of Ophthalmology & Visual Science, 4(1), 24-29. https://doi.org/10.11648/j.ijovs.20190401.15

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ACS Style

Tal Paz; Niv Levy; Hana Leiba; Daniel Rappoport. Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. Int. J. Ophthalmol. Vis. Sci. 2019, 4(1), 24-29. doi: 10.11648/j.ijovs.20190401.15

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AMA Style

Tal Paz, Niv Levy, Hana Leiba, Daniel Rappoport. Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies. Int J Ophthalmol Vis Sci. 2019;4(1):24-29. doi: 10.11648/j.ijovs.20190401.15

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@article{10.11648/j.ijovs.20190401.15,
  author = {Tal Paz and Niv Levy and Hana Leiba and Daniel Rappoport},
  title = {Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {4},
  number = {1},
  pages = {24-29},
  doi = {10.11648/j.ijovs.20190401.15},
  url = {https://doi.org/10.11648/j.ijovs.20190401.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20190401.15},
  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, pConclusions: 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.},
 year = {2019}
}

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TY  - JOUR
T1  - Role of Early Neuroimaging in Managing Acute Isolated Ocular Motor Nerve Palsies
AU  - Tal Paz
AU  - Niv Levy
AU  - Hana Leiba
AU  - Daniel Rappoport
Y1  - 2019/06/11
PY  - 2019
N1  - https://doi.org/10.11648/j.ijovs.20190401.15
DO  - 10.11648/j.ijovs.20190401.15
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 24
EP  - 29
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20190401.15
AB  - 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, pConclusions: 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.
VL  - 4
IS  - 1
ER  -

Copy | Download