Clinical Prediction Score for Early Neuroimaging in Acquired Isolated Oculomotor Nerve Palsy

• Published in: Eye and brain 2020-01, Vol.12, p.89-95
• Main Authors: Witthayaweerasak, Juthamat, Tansuebchueasai, Natchada, Aui-Aree, Nipat
• Format: Article
• Language: English
• Subjects: Age; Aneurysm; Aneurysms; Cardiovascular disease; Development and progression; Diplopia; Ethics; Etiology; Head injuries; Health aspects; Infections; Inflammation; Ischemia; Magnetic resonance imaging; Motility; Neuroimaging; Neurological disorders; Neurosurgery; oculomotor nerve palsy; Original Research; Patients; predictor; Risk factors; Studies; third nerve palsy
• ISSN: 1179-2744; 1179-2744
• DOI: 10.2147/EB.S253305

An immediate neuroimaging investigation in patients with isolated oculomotor nerve palsy (ONP) remains controversial. We aimed to develop a clinical prediction score to determine whether or not acquired isolated ONP patients require prompt imaging. A retrospective study was performed. Demographic data and clinical presentations were collected to determine predictive factors favored for early brain imaging using multivariate logistic regression analysis. Ninety-seven eyes of 96 patients diagnosed with isolated ONP were included. Forty-one eyes (42.3%) were caused by ischemia, while the other 56 eyes (57.7%) were caused by non-ischemic etiologies, namely aneurysm (n = 22), trauma (n = 18), inflammation (n = 5), tumor (n = 4), and others (n = 7). Eighty-two eyes (84.5%) had undergone neuroimaging study due to initially suspected non-ischemic causes. Only 36 (43.9%) revealed concordant diagnosis. The potential clinical predictors favored for neuroimaging using multivariate logistic regression analysis were age 10‒50 years (adjusted odds ratio [aOR] 9.01, 95% CI: 1.25‒64.8), age 51‒70 years (aOR 1.71, 95% CI: 0.46‒6.35), history of head trauma (aOR 7.14, 95% CI: 1.19‒42.9), absence of vascular risk factors (aOR 3.85, 95% CI: 1.23‒12.1), and poor pupillary response (aOR 6.96, 95% CI: 1.99‒24.3). The predictor scores with an area under the ROC curve of 0.852 were 4, 1, 4, 3, and 4, respectively. The optimum cut-point was 3 for a sensitivity of 96% and specificity of 44%. Patients with acquired isolated ONP should be considered early neuroimaging studies when they are younger than 50 years old, have a history of head trauma, have no history of vascular risk factors, or have poor pupillary reaction.