Arsen AKINCI*, Gölge ACAROĞLU**, Beyazıt İLHAN*, Orhan ZİLELİOĞLU***

ÖZET

Amaç: İzole 3, 4 veya 6. kranial sinir felci olan erişkin hastalardaki nedenleri ve prognozu incelemek.
Gereç ve Yöntem: Son 13 yılda nörooftalmoloji bölümüne sevk edilmiş 3, 4 veya 6. kranial sinir felci olan 69 erişkin hasta retrospektif olarak incelendi. 23 hastada unilateral 6. sinir felci, 10 hastada bilateral 6. sinir felci, 20 hastada unilateral 3. sinir felci, 15 hastada unilateral 4. sinir felci ve 1 hastada bilateral 4. sinir felci mevcuttu. Her hastada kranial sinir felcinin nedenini bulmaya yönelik laboratuar ve görüntüleme tetkikleri yapıldı. Hastalar  6 ile 8 ay (ortalama:7.2 ay) süreyle takip edilip, sinir felcinin prognozu kaydedildi.
Bulgular: İzole 4. sinir felci olan 16 hastanın 5’inde (% 31.25) neden travma, 5’inde (%31.25) ise diabetes mellitus (DM) ve hipertansiyon (HT) gibi vasküler hastalıklar idi. İzole 6. sinir felci olan 33 hastanın 15’inde (%45.45) neden vasküler hastalıklar, 8’inde (%24.24) idyopatik intrakranyal hipertansiyon (İİHT) idi. İzole 3. sinir felci olan 20 hastanın 10’unda (%50) neden vasküler hastalıklar, 2’sinde (%10) travma idi. İzole 6. sinir felci olan 33 hastanın 28’inde (%84.84), izole 4. sinir felci olan 16 hastanın 9’unda (%56.25) ve izole 3. sinir felci olan 20 hastanın 14’ünde (%70) tam düzelme görüldü. Vasküler hastalıklara bağlı 3, 4 veya 6. sinir felci olan 30 hastanın hepsinde (%100) düzelme görülürken, travmaya bağlı 11 hastanın 3’ünde (%27.2), İİHT’ye bağlı 8 hastanın hepsinde (%100) düzelme görüldü.
Sonuç: Bizim serimizde izole 3 ve 6. sinir felci olan erişkin hastalarda en sık neden vasküler hastalıklar iken, izole 4. sinir felci olgularında en sık neden vasküler hastalıklar ile birlikte travma idi. Ek olarak diğer bütün nedenlere bağlı olgularda prognoz, travmatik olgulara göre oldukça iyi idi.
Anahtar Kelimeler: Oküler nöropati, Diplopi, Mikrovasküler hastalıklar

Palsies of Isolated 3th, 4th, 6th Cranial Nerves in Adult Patients:
Etiology and Prognosis

Summary

Purpose: To evaluate the etiology and prognosis in adult patients with isolated 3rd, 4th or 6th cranial nerve palsies.
Material and Method: Sixty-nine adult patients with 3rd, 4th or 6th cranial nerve palsies who were referred to neuroophthalmology section in last 13 years were retrospectively evaluated. There were unilateral 6th nerve palsies in 23 patients, bilateral 6th nerve palsies in 10 patients, unilateral 3rd nerve palsies in 20 patients, unilateral 4th nerve palsies in 15 patients and bilateral 4th nerve palsies in 1 patient. In each patient neuroimaging and laboratory analysis in order to find out the etiology of cranial nerve paralysis were done. The patients were followed between 6 to 8 months (average:7.2 months), and the prognosis of nerve palsies were noted.
Results: Among 16 patients with isolated 4th nerve palsy, the cause was trauma in 5 patients (31.25%) and vascular disease such as diabetes mellitus (DM) and hypertension (HT) in 5 (31.25%). Among 33 patients with isolated 6th nerve palsy, the cause was vascular disease in 15 patients (45.45%) and idiopathic intracranial hypertension (IIHT) in 8 (24.24%). Among 20 patients with isolated 3rd nerve palsy, the cause was vascular disease in 10 patients (50%), trauma in 2 (%10). Complete recovery was seen in 28 (84.84%) of  33 patients with isolated 6th nerve palsy, in 9 (56.25%) of 16 patients with isolated 4th nerve palsy and in 14 (70%) of 20 patients with isolated 3rd nerve palsy. Recovary was complete in all of the 30 patients (100%) with 3rd, 4th or 6th nerve palsies due to vascular diseases, in 2 of 9 patients (22.22%) due to trauma and in all of  8 patients (100%) due to IIHT.
Conclusion: In our series, in adult patients with isolated 3rd and 6th nerve paralysis the most common cause was vascular disease, while in cases with 4th cranial nerve paralysis it was vascular disease together with trauma. Additionally prognosis in all other cases was much better than the traumatic cases.
Key Words: Ocular neuropathy, Diplopia, Microvascular diseases