Stroke and transient ischemic attack incidence after acute microvascular ocular motor palsies

Abstract

Background: In the past, microvascular ocular motor palsies (OMPs) have been regarded as a benign vascular condition with excellent prognosis. Purpose: To determine the incidence of subsequent stroke or transient ischemic attack (TIA) in acute isolated microvascular third, fourth and sixth cranial nerve palsies. Methods: The medical records of 95 consecutive patients presenting with ocular motor palsies (OMPs) in the Emergency Department of Coimbra University Hospital Center between January 2007 and October 2012 were reviewed. Results: Six out of 57 patients (10,5%) with presumed microvascular OMPs had subsequent stroke or TIA, 4 during the first year, 1 during the second year and 1 patient after this period. In comparison, only 1 out of 38 control subjects (2,5%) with non-microvascular OMPs developed subsequent stroke, albeit this difference has not reached statistical significance (P=0,149). Cumulative incidence of subsequent stroke or TIA was higher for the microvascular group, although not significantly (p=0,217). In the microvascular OMP group, age (p=0,633), gender (p=0,272), cranial nerve affected (p=0,256), the number of vascular risk factors (p=0,598), and the use of an antiplatelet agent before (p=0,313) or after the OMP (p=0,164), did not differed significantly between patients who had a subsequent stroke or TIA and those who did not. Conclusions: A significant proportion of patients with presumed microvascular OMPs developed subsequent stroke, approaching stroke recurrence rates previously reported for other stroke types (e.g., lacunar stroke). This finding emphasizes the importance of initiating a focused secondary prevention strategy when managing patients with presumed microvascular OMPs.