Etiological And Clinical Profile Of 3rd, 4th, 6th, And Multiple Cranial Nerve Palsies In A Tertiary Care Center

Abstract

Introduction
Lower motor neuron cranial neuropathies, whether isolated or combined, pose significant diagnostic and therapeutic challenges due to diverse underlying causes. Regional data on their distribution and determinants remain limited, particularly in this study aimed to analyze the incidence, clinical spectrum, and etiological patterns of third, fourth, sixth, and multiple cranial nerve palsies in patients attending a tertiary care hospital.

Method
A cross-sectional observational study was conducted at Avicenna Medical College (AMC) and Hospital from November 2024 to April 2025. Consecutive cases of third, fourth, sixth, or combined lower motor neuron cranial nerve palsies were enrolled. Patients with first or second nerve involvement, neuromuscular junction disease, or primary muscle pathology were excluded. Detailed clinical evaluation, laboratory testing, electrophysiology, and neuroimaging were performed. Associations were analyzed using chi-square and correlation tests.

Results
A total of 388 patients were assessed. The mean age at presentation was 53.5 years, with male predominance across all groups. Third nerve palsy was most frequent (26.6%), followed by fourth (21.5%), sixth (19.8%), and multiple (9.2%). Ischemic cerebrovascular disease was the leading cause, especially in single nerve palsies, while tumors, aneurysms, and trauma were more frequent in multiple involvement. Hypertension, diabetes, smoking, and alcohol emerged as major risk factors.

Conclusion
Cranial nerve palsies predominantly affect middle-aged men, with ischemia and vascular comorbidities as key contributors. Infections and neoplastic processes remain important in younger or multiple nerve presentations. Recognition of demographic and risk factor patterns may guide timely diagnosis and management.