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Pediatric third, fourth, and sixth nerve palsies: a population-based study
J M Holmes1, S Mutyala, T L Maus
1Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. holmes.jonathan@mayo.edu
Insights
This study found the annual incidence of childhood cranial nerve palsies affecting ocular motility to be 7.6 per 100,000. Congenital causes were most common, and intracranial neoplasia was not an isolated finding.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Epidemiology
Background:
- Cranial nerve palsies affecting ocular motility are a significant cause of visual impairment in children.
- Previous studies have primarily focused on institution-based referral series, potentially limiting generalizability.
Purpose of the Study:
- To determine the population-based incidence and causes of third, fourth, and sixth cranial nerve palsies in children.
- To provide epidemiological data from a geographically defined population.
Main Methods:
- Utilized the Rochester Epidemiology Project medical records linkage system for case identification (1978-1992).
- Included residents under 18 years of age.
- Reviewed medical records to confirm diagnoses, ascertain causes, and establish residency.
Main Results:
- Identified 36 incidence cases in 35 children over 15 years.
- Reported an age- and sex-adjusted annual incidence of 7.6 per 100,000 children.
- Fourth nerve palsy was most common (36%), followed by sixth (33%) and third (22%).
- Congenital causes predominated for third and fourth nerve palsies; undetermined for sixth; trauma for multiple palsies.
Conclusions:
- Population-based data offer a more accurate incidence of childhood cranial nerve palsies than referral series.
- Congenital etiology is more prevalent than previously reported in institutional studies.
- Intracranial neoplasia did not present as an isolated cranial nerve palsy in this cohort.
Purpose:
To determine the population-based incidence and cause of cranial nerve palsies affecting ocular motility in children in the circumscribed population of Olmsted County, Minnesota.
Methods:
The Rochester Epidemiology Project medical records linkage system captures virtually all medical care provided to Olmsted County residents. By means of this database, all cases of third, fourth, and sixth cranial nerve palsy were identified among county residents less than 18 years of age from 1978 through 1992. Medical records were reviewed to confirm the diagnosis, determine the cause, and document county residency. Incidence rates were adjusted to the age and sex distribution of the 1990 white population in the United States.
Results:
Over this 15-year period, 36 incidence cases of cranial nerve palsy were identified in 35 children in this defined population. The age-adjusted and sex-adjusted annual incidence of third, fourth, and sixth nerve palsies combined was 7.6 per 100,000 (95% confidence interval, 5.1 to 10.1). The most commonly affected nerve was the fourth (36%), followed by the sixth (33%), the third (22%), and multiple nerve palsies (9%). The most common cause was congenital for third and fourth nerve palsy, undetermined for sixth, and trauma for multiple nerve palsies. Although three cases were associated with neoplasia, a cranial nerve palsy was not present at the time of diagnosis in any case.
Conclusions:
Unlike many institutionally based referral series, our population-based study provides data on the incidence and cause of third, fourth, and sixth nerve palsies in a geographically defined population. In contrast to previous institutionally based series, nearly half the cases were congenital in origin, and in no case did intracranial neoplasia present as an isolated nerve palsy.