Recovery estimates and prognostic factors for oculomotor nerve palsy

Third cranial nerve (III CN) palsy is an extremely disabling condition with several etiologies and clinical onsets. Identifying the underlying causes and individual risk factors is critical to determine prognosis and guide treatment.

To analyze factors associated with III CN palsy, estimate recovery rates across different etiologies, and identify independent predictors of recovery, considering patient characteristics and comorbidities.

A retrospective study was performed, including demographics and neurological data of a consecutive series of patients affected by III CN palsy from 2010 onwards. All patients underwent neurological examination, routine neuroimaging, and follow-up. Kaplan-Meier curve and the log-rank method were used to estimate recovery rates by etiology. Univariate and multivariate logistic regressions assessed patient-specific factors as independent predictors of recovery. Statistical significance was fixed as p-value < 0.05.

Overall, 50 patients were included. The prevailing causative factors were microangiopathy in 36% and miscellaneous in 36% of cases. Hypertension (50%), diabetes mellitus (34%), and cardiovascular diseases (14%) were the predominant comorbidities. Total recovery of the oculomotor function was found in 46% of patients. Kaplan-Meier analysis reported microangiopathy and syndromes as etiological factors significantly related to early recovery time. Age and pupillary involvement emerged as significant independent prognostic factors.

The etiology significantly influences the recovery estimates of the oculomotor function. At the same time, patients' age, pupillary involvement, and especially hypertension as a comorbidity were the main predictive factors of good outcomes. More extensive studies are required to confirm these findings and include then in clinical practice.