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Etiology of lateral rectus palsy in infancy and childhood
A K Afifi1, W E Bell, A H Menezes
1Department of Pediatrics, University of Iowa, Iowa City.
Insights
Trauma, tumors, and congenital issues are the leading causes of lateral rectus palsy in children. This study offers a multidisciplinary view, unlike prior ophthalmology-focused research.
Area of Science:
- Pediatric Neurology
- Pediatric Ophthalmology
- Pediatric Neurosurgery
Background:
- Lateral rectus palsy in children requires specific etiological consideration distinct from adult populations.
- Existing literature often lacks a comprehensive, multidisciplinary approach to childhood lateral rectus palsy.
Purpose of the Study:
- To retrospectively review and analyze the etiologies of lateral rectus palsy in a pediatric cohort.
- To compare findings with existing literature, emphasizing a multidisciplinary perspective from neurology, neurosurgery, and ophthalmology.
Main Methods:
- Retrospective chart review of 132 infants and children diagnosed with lateral rectus palsy over 22 years.
- Analysis of etiological factors, clinical presentation, and outcomes across different pediatric subspecialties.
Main Results:
- The most common etiologies identified were trauma, tumors, and congenital factors.
- Most cases presented as unilateral lateral rectus palsy, with no significant side predilection.
- Tumors were predominantly primary and infratentorial; trauma and tumors often associated with other neurological signs.
Conclusions:
- Trauma, tumors, and congenital anomalies are key causes of pediatric lateral rectus palsy.
- A combined pediatric neurology, neurosurgery, and ophthalmology approach is crucial for accurate diagnosis and management.
- Idiopathic cases and benign recurrent forms represent a smaller proportion of childhood lateral rectus palsy.
Abstract:
The etiologies of lateral rectus palsy in 132 infants and children seen over a period of 22 years in a university medical center were retrospectively reviewed and compared with similar reports in the literature. Unlike most reports, which lump children with adults, this study focuses on childhood etiologies of lateral rectus palsy. In contrast to the only two studies in the literature on childhood lateral rectus palsy, which reflect a purely ophthalmologic perspective, this study reflects experiences of pediatric neurology and pediatric neurosurgery, as well as ophthalmology. Most lateral rectus palsies were unilateral, almost equally distributed between right and left sides. Trauma, tumor, and congenital etiologies were the most prevalent. The relative frequency of each of these etiologies varies by service (neurology, neurosurgery, ophthalmology). In 10.6% of patients, etiology could not be determined. The majority of patients had an isolated lateral rectus palsy. Association of lateral rectus palsy with other cranial nerve palsies and/or long tract signs characterized trauma and tumor. The majority of tumors were primary and infratentorial. A small number of patients had benign recurrent lateral rectus palsy.