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Ocular Motor Palsy After Spinal Puncture.

Monica Del-Rio-Vellosillo¹, José J Garcia-Medina, Maria Dolores Pinazo-Duran

¹From the *Department of Anesthesia, University Hospital Virgen de la Arrixaca; and †Department of Ophthalmology and Optometry, University School of Medicine, Murcia; and ‡Department of Ophthalmology, University School of Medicine, Valencia; and §Department of Anesthesia, University Hospital La Fe, Valencia, Spain.

Regional Anesthesia and Pain Medicine

|November 16, 2016

Summary

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Ocular motor palsy, a rare complication of spinal puncture, most often affects the sixth cranial nerve. Early recognition and treatment are crucial for managing this condition, which predominantly impacts females.

Area of Science:

Neurology
Ophthalmology
Anesthesiology

Background:

Ocular motor palsy is a rare but significant complication following subarachnoid puncture.
Cranial nerve palsies (III, IV, VI) can occur after spinal anesthesia, necessitating a thorough understanding of their characteristics and management.

Purpose of the Study:

To comprehensively review the literature on ocular motor palsies secondary to subarachnoid puncture.
To analyze the incidence, affected cranial nerves, patient demographics, onset, duration, and treatment outcomes of these palsies.

Main Methods:

A systematic literature search was conducted on PubMed for articles concerning cranial nerves III, IV, and VI palsies post-spinal puncture.
Data from 114 cases reported in 65 articles (1930-2015) were analyzed.

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Main Results:

Subarachnoid anesthesia was the most frequent cause (45.6%), with a higher incidence in females.
The sixth cranial nerve was most commonly affected (92.1%), particularly in the right eye, with onset approximately 7 days post-puncture.
Most cases were reversible, with a mean duration of 80 days; permanent paresis occurred in 13 patients.

Conclusions:

Ocular motor palsy following subarachnoid puncture is a recognized complication, predominantly affecting the sixth cranial nerve.
Early diagnosis and appropriate management, including conservative measures, are essential for favorable outcomes.
Further research may clarify the controversial role of blood patches in treating these palsies.