title: Diabetes and hypertension in isolated sixth nerve palsy: a population-based study.
abstract: OBJECTIVE
  Diabetes mellitus and systemic hypertension are frequently reported as ischemic causes of sixth nerve palsy/paresis, but there are few rigorous studies to support these associations. We conducted a population-based case-control study to determine the presence and magnitude of any association of preexisting diabetes mellitus and systemic hypertension with isolated sixth nerve palsy.
  
  
  METHODS
  Retrospective population-based case-control study.
  
  
  METHODS
  Participants were patients with new onset of neurologically isolated sixth nerve palsy or paresis (n = 76) in Olmsted County, Minnesota, from January 1, 1978, to December 31, 1992. Controls (n = 76) were selected from the same general population and were matched for age, gender, and length of medical follow-up.
  
  
  METHODS
  Using the Rochester Epidemiology Project medical records linkage system, which captures virtually all medical care provided to residents of Olmsted County, Minnesota, we identified all incident cases of neurologically isolated sixth nerve palsy/paresis (n = 76) among county residents between the given dates. An equal number (n = 76) of controls were randomly selected from the general population. We reviewed the entire medical record of each case and control, using stringent predetermined criteria to define the presence of diabetes mellitus and systemic hypertension. We compared the prevalence of diabetes and systemic hypertension between cases and controls by use of chi-square tests, and we calculated odds ratios (OR) with 95% confidence intervals (CI).
  
  
  METHODS
  Presence or absence of diabetes mellitus and systemic hypertension.
  
  
  RESULTS
  Diabetes mellitus occurred more frequently in cases (23.7%) than in controls (5.3%; P = 0.001; OR, 5.59; 95% CI, 1.79-17.42). Systemic hypertension occurred with similar frequency in cases (51.3%) and controls (39.5%; P = 0.14; OR, 1.62; 95% CI, 0.85-3.08). Coexistent diabetes mellitus and hypertension were more common in cases (18.4%) than in controls (2.6%; P = 0.002; OR, 8.36; 95% CI, 1.83-38.18).
  
  
  CONCLUSIONS
  We conclude that there is a 6-fold increase in odds of having diabetes in cases of sixth nerve palsy over controls, whereas systemic hypertension does not seem to be associated with increased odds. In contrast, there is an 8-fold increased odds of having coexistent diabetes and hypertension in cases of sixth nerve palsy over controls. The much-cited association of systemic hypertension alone with sixth nerve palsy may be coincidental.
authors.affiliation: Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Patel
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Holmes
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: James P
authors.initials: JP
authors.lastname: Burke
mesh_terms: D020434:Abducens Nerve Diseases / Q000150:complications* / Q000453:epidemiology; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D008498:Medical Record Linkage; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D011159:Population Surveillance; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors