Majority of isolated fourth nerve palsies are congenital

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FEB 14, 2018

Neuro-Ophthalmology/Orbit


This population-based study evaluated the incidence and etiology of isolated, presumed fourth nerve palsy.

Study design

The authors used a database of Olmsted County, Minnesota, residents to identify all cases of isolated fourth nerve palsy diagnosed over a 15-year period.

Outcomes

Seventy-three patients were identified; mean age at presentation was 41.8 years. After adjustment for age and sex, the annual incidence rate was 5.73 per 100,000 per year, with a higher incidence in males than females.

The most common etiology was presumed congenital (49%), followed by hypertension (18%) and trauma (18%). One patient (1%) had fourth nerve palsy owing to a known intracranial neoplasm. The cause was undetermined for 3 patients (4%).

The most common decade of presentation was the fourth decade, including for presumed congenital cases.

Limitations

The population studied was predominately white. Thus, the results may be different for a more diverse population.

Clinical significance

This is an important review because it highlights the different etiologies of fourth cranial palsies. The findings further support that a vasculopathic etiology is just as common as head trauma, and in no case was an isolated fourth nerve palsy the presenting sign of an intracranial tumor.

View Abstract American Journal of Ophthalmology, January 2018

https://www.aao.org/editors-choice/majority-of-isolated-fourth-nerve-palsies-are-cong

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