Isolated oculomotor palsy in adults: an integrative review of etiologies, clinical patterns, and radiological findings

Isolated oculomotor palsy in adults represents a clinically significant neurological condition associated with a wide range of etiologies, including microvascular, traumatic, inflammatory, demyelinating, and compressive causes. This study aimed to investigate the association between different etiological factors and the development of isolated palsy of cranial nerves III, IV, and VI, as well as to identify the most prevalent clinical and radiological patterns. An integrative literature review was conducted using the PubMed database, including studies published within the last 5 to 10 years that directly addressed the topic. After a systematic selection process, eight studies were included in the final analysis. The findings indicate that microvascular etiologies—particularly those related to systemic arterial hypertension and diabetes mellitus—are the most common and are generally associated with favorable recovery. However, compressive causes such as intracranial aneurysms and sellar region tumors, although less frequent, carry greater clinical severity and prognostic impact. Pupillary involvement and isolated clinical signs were shown to be unreliable in excluding serious underlying conditions. In conclusion, diagnostic evaluation should be individualized, with a low threshold for neuroimaging, especially in younger patients, in the absence of vascular risk factors, or when additional neurological signs are present.