The authors present a retrospective case review of new patient presentations to a neuro-ophthalmology clinic at two centres between 2014 and 2017. The electronic medical records were searched using the variety of terms for third nerve palsy. Referral for management of a long-standing third nerve palsy were excluded from the study. The correct diagnosis was deemed to be that made by the neuro-ophthalmologist. If the final diagnosis was not third nerve palsy, a review of the diagnostic error was conducted by two independent reviewers. Seventy-eight patients were included in the study, with 61 confirmed with a diagnosis of third nerve palsy. The remaining 17 patients had a range of alternative diagnoses. Optometrists were reported to be the most likely to refer a third nerve palsy which subsequently was given an alternative diagnosis. The cause of misdiagnosis was reported to be failure to elicit or interpret the clinical examination, with significant differences in clinical findings reported between the two groups. The authors highlight several limitations with this study. Areas for attention to improve diagnostic accuracy are suggested.
Prevalence of misdiagnosis of third nerve palsy by referring clinicians
Reviewed by Lauren Hepworth
Misdiagnosis of third nerve palsy.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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