Abstract
Background
Neurologically isolated ocular motor nerve palsies often present a management dilemma. Neuroimaging is more likely to be offered to patients <50 years without coexisting ischaemic risk factors as their risk of sinister underlying causes is thought to be higher. However, populations are rapidly ageing and advanced neuroimaging is now more widely available. We thus investigated the incidence of abnormal neuroimaging outcomes in the traditionally low-risk older patient group.
Methods
This is a retrospective cohort study of 353 patients presenting with isolated ocular motor nerve palsies to a tertiary neuro-ophthalmology service in Singapore over a four-year (2015 to 2019) period. Clinical data was obtained through manual review of case records. Common aetiologies, age-based differences in prevalence of causes and abnormal neuroimaging outcomes were statistically analysed.
Results
Abnormal neuroimaging outcomes were significantly greater in the younger cohort only when age segregation was performed at 60 years of age. In a multivariate analysis, acute onset rather than ischaemic risk factors were independently predictive of normal neuroimaging outcomes. After adjusting for prior cancer risk and clinical bias from presumed ischaemic palsies, abnormal neuroimaging outcomes were seen in 14.1% ≥ 50 yrs, 10.9% ≥ 60 yrs and 15.1% ≥ 70 yrs.
Conclusions
In patients presenting with isolated ocular motor nerve palsies, acute onset may be a more reliable indicator of an ischaemic palsy rather than advanced age or presence of ischaemic risk factors. If onset is not acute, neuroimaging should be considered irrespective of age and coexisting ischaemic risk factors.
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Data availability
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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SYC analysed the data and wrote the manuscript together with SS. JX collected the data. ST, DM, JL and SS conceptualised and helped to supervise the project with SS primarily supervising. All authors discussed the results and contributed to the final manuscript. We thank and acknowledge Prof Umapathi N Thirugnanam for critical comments on the manuscript.
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Chan, SY.C., Hsu, J.CL., Tow, S.L.C. et al. Are isolated ocular motor nerve palsies in the elderly truly ‘low risk’ for abnormal neuro-imaging outcomes?. Eye 38, 773–777 (2024). https://doi.org/10.1038/s41433-023-02775-7
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DOI: https://doi.org/10.1038/s41433-023-02775-7
