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Cet abstract a été assigné à session OBAO: Organisatie van Belgische Assistenten in Oftalmologie/Organisation Belge des Assistants en Ophtalmologie

Titre

Persistent diplopia-workup for acute oculomotor palsies

But	To discuss the most appropriate work-up for acute oculomotor nerve palsies in children and adult patients.
Méthodes	Through the presentation of different clinical cases, the diagnostic approach for oculomotor palsies will be discuss.
Résultats	In children, the most common cause for the III and IV nerve is congenital followed by trauma. For the acquired VI nerve palsy the major diagnostic criteria are trauma, benign recurrent nerve palsy, elevated intracranial pressure, and pontine glioma. In adult, the VI nerve palsy is the most common ocular motor palsy. If the abducens nerve palsy is isolated in a vasculopathic pat > 50yo, usually it resolve within 3 mo. In this case neuroimaging is not required. A cranial MRI will be mandatory if no recovery is observed after 3mo.But VI nerve palsy in a patient less then 50yo require careful scrutinity, and should undergo cranial MRI.An isolated IV nerve palsy in a pat >50yo is typically caused by microvascular disease. In case of lack of recovery after 3 mo an MRI should be performed. The IV nerve is particularly vulnerable to head trauma, and bilateral IV nerve palsy should be always considered. Partial III nerve palsy is more common. A III nerve palsy with pupillary involvement or evidence of progression to papillary involvement must be assumed to be secondary to an aneurysm until proven otherwise. Anevrysms are uncommon before 20yo, but may be present already in the first decade of age. Pupil-sparing third nerve palsy is almost always benign and secondary to a microvascular disease, especially related to diabetes.
Conclusion	Differential diagnosis and practical guidelines will be presented for each of the oculomotor nerve palsies.

Auteur 1

Nom	BOSCHI
Initiales	A
Institut	Cliniques Universitaires St Luc
Ville	Bruxelles