Neuroimaging and Acute Ocular Motor Mononeuropathies

Abstract

The traditional teaching in neuro-ophthalmology is that patients with isolated ocular motor mononeuropathies and risk factors for microvascular disease, with certain exceptions, may be safely followed clinically without neuroimaging. These exceptions include patients younger than 50 years, with other neurologic findings, with a progressive course of diplopia, or with a known history of cancer. This practice pattern is based on the results of natural history studies of the common causes of isolated mononeuropathies in various age groups.^1-4 In patients without the exceptions we have noted, the rate of finding an underlying cause for an acute mononeuropathy is low, with reports ranging up to 14%.^1,5,6