Background

Ocular motor nerve palsies (OMNP) frequently cause patients to present in an emergency room. In the following study, we report the differential diagnosis of OMNP by use of magnetic resonance imaging (MRI) and CSF examination as a standard.

Method

We performed a data analysis of N = 502 patients who presented with oculomotor, trochlear, and/or abducens nerve palsy in the emergency room of the Department of Neurology, University of Ulm, between January 2006 and December 2019. We report clinical and MRI scan findings in all patients; furthermore, the CSF of 398 patients has been analysed.

Results

Abducens nerve palsies were most common (45%), followed by palsies of the oculomotor (31%) (CNP III) and trochlear nerve (15%). Multiple OMNPs were seen in 9% of our cohort. The most common causes included inflammations (32.7%), space-occupying lesions, such as aneurysms or neoplasms (17.3%), diabetes mellitus (13.3%), and brainstem infarctions (11%). Still 23.4% of the patients could not be assigned to any specific cause after differential diagnostic procedures and were described as idiopathic. One of three patients with an inflammation and 39% of the patients with space-occupying lesions showed additional cranial nerve deficits.

Conclusion

Inflammation and space-occupying processes were the most frequent causes of OMNP, although brainstem infarctions also play a significant role, in particular in CNP III. The presence of additional CNPs increases the probability of an inflammatory or space-occupying cause.

中文翻译：

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获得性眼运动神经麻痹的谱系和鉴别诊断：502例患者的临床研究

背景

眼运动神经麻痹 (OMNP) 经常导致患者出现在急诊室。在以下研究中，我们报告了以磁共振成像 (MRI) 和脑脊液检查为标准对 OMNP 的鉴别诊断。

方法

 我们对 2006 年 1 月至 2019 年 12 月期间在乌尔姆大学神经内科急诊室出现动眼神经、滑车和/或外展神经麻痹的N = 502 名患者进行了数据分析。我们报告了临床和 MRI 扫描所有患者的发现；此外，还分析了 398 名患者的 CSF。

结果

外展神经麻痹最常见（45%），其次是动眼神经麻痹（31%）（CNP III）和滑车神经麻痹（15%）。在我们的队列中，有 9% 出现了多个 OMNP。最常见的原因包括炎症（32.7%）、占位性病变，如动脉瘤或肿瘤（17.3%）、糖尿病（13.3%）和脑干梗塞（11%）。仍有 23.4% 的患者在鉴别诊断程序后无法归类为任何特定原因，并被描述为特发性。三名患有炎症的患者中的一名和 39% 的占位性病变患者表现出额外的颅神经缺损。

结论

炎症和占位过程是 OMNP 最常见的原因，尽管脑干梗塞也起着重要作用，特别是在 CNP III 中。额外 CNP 的存在增加了炎症或占位原因的可能性。