Guichen Li1, Xiaobo Zhu2, Xiuhong Gu3, Yang Sun2, Xianfeng Gao2, Yang Zhang4, Kun Hou5. 1. Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China. 2. Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China. 3. Department of Internal Medicine, The Middle School Hospital of Tonghua Iron and Steel Group, Tonghua, Jilin, China. 4. Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China. Electronic address: zhangyang_930@126.com. 5. Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China. Electronic address: hkyyayz@yeah.net.
Abstract
BACKGROUND: Ocular movement nerve (cranial nerve III, IV and VI) palsy (OMNP) is rarely encountered after mild head trauma. As a result of the inconsistent definition of this specific entity in published studies, it is difficult to offer an accurate management strategy and prognosis assessment to affected patients. METHODS: A retrospective review of the medical records of the patients at the First Hospital of Jilin University combined with a systematic review of published studies was conducted. RESULTS: Thirty-one patients (17 females, 55%), including 6 cases in our institution, were identified in this systematic review. Cranial nerves III, IV, and VI were involved in 54.8%, 3.2%, and 45.2% of the patients, respectively. Although all the patients in our case series experienced complete resolution, only 54.6% experienced complete resolution in a time course of 10 days to 13 months. Additional intracranial findings other than traumatic brain injury on imaging modalities that might predispose to OMNP after mild head trauma were identified in 25.8% of the patients. CONCLUSIONS: OMNP after mild head trauma is a rare entity in neurosurgical practice. In patients with no positive intracranial finding, observation and follow-up are the mainstay of management. If any underlying intracranial lesions are identified, the management should be focused on the underlying lesions. From the data available, mild trauma does not mean mild injury or favorable recovery in OMNP after mild head trauma.
BACKGROUND:Ocular movement nerve (cranial nerve III, IV and VI) palsy (OMNP) is rarely encountered after mild head trauma. As a result of the inconsistent definition of this specific entity in published studies, it is difficult to offer an accurate management strategy and prognosis assessment to affected patients. METHODS: A retrospective review of the medical records of the patients at the First Hospital of Jilin University combined with a systematic review of published studies was conducted. RESULTS: Thirty-one patients (17 females, 55%), including 6 cases in our institution, were identified in this systematic review. Cranial nerves III, IV, and VI were involved in 54.8%, 3.2%, and 45.2% of the patients, respectively. Although all the patients in our case series experienced complete resolution, only 54.6% experienced complete resolution in a time course of 10 days to 13 months. Additional intracranial findings other than traumatic brain injury on imaging modalities that might predispose to OMNP after mild head trauma were identified in 25.8% of the patients. CONCLUSIONS: OMNP after mild head trauma is a rare entity in neurosurgical practice. In patients with no positive intracranial finding, observation and follow-up are the mainstay of management. If any underlying intracranial lesions are identified, the management should be focused on the underlying lesions. From the data available, mild trauma does not mean mild injury or favorable recovery in OMNP after mild head trauma.