{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:55:58Z","timestamp":1788389758866,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Oculomotor nerve palsy (OMNP) is a clinically significant condition that may represent the earliest manifestation of life-threatening intracranial pathology, particularly aneurysmal compression or neoplasia. Despite its neurosurgical relevance, comprehensive meta-analytic evidence synthesizing OMNP etiologies, clinical presentation, and contemporary diagnostic pathways remains limited. Methods: Following PRISMA 2020 guidelines, MEDLINE, Scopus, and Web of Science were systematically searched for studies reporting quantitative data on OMNP. Pooled prevalence estimates were calculated using random-effects models for causes and symptoms, while a structured narrative synthesis was performed for diagnostic modalities because outcome reporting was heterogeneous and unsuitable for meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute (JBI) risk of bias tool. Results: Twenty-four studies involving 5541 patients were included. Using a multivariate multilevel model to account for within-study dependence, the most common etiological category was vascular disorders (35.62%), followed by idiopathic (16.47%) and neoplastic (12.10%). Head trauma and aneurysms accounted for 11.26% and 10.08% of cases, respectively. Diplopia (60.63%) and ptosis (54.12%) remained the predominant clinical symptoms, while pupil involvement was identified in 40.62% of the pooled population. Diagnostic paradigms have shifted decisively toward non-invasive neuroimaging, with magnetic resonance imaging reported in 66% of included studies and magnetic resonance or computed tomographic angiography increasingly employed to identify surgically relevant vascular lesions. Conclusions: Although vascular disorders represented the most common etiological category, the notable prevalence of aneurysmal and neoplastic causes underscores the importance of prompt high-resolution neuroimaging and early neurosurgical assessment. Early recognition and etiological stratification remain essential to optimize management and prevent irreversible neurological morbidity.<\/jats:p>","DOI":"10.3390\/diagnostics16091401","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:01:39Z","timestamp":1778140899000},"page":"1401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Oculomotor Nerve Palsy\u2014Etiologies, Symptoms and Diagnosis: A Systematic Review with Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2785-4095","authenticated-orcid":false,"given":"Konstantina","family":"Bolou","sequence":"first","affiliation":[{"name":"School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0122-2436","authenticated-orcid":false,"given":"George","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0783-5700","authenticated-orcid":false,"given":"Nikolaos-Achilleas","family":"Arkoudis","sequence":"additional","affiliation":[{"name":"Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, 11528 Athens, Greece"},{"name":"Second Department of Radiology, General University Hospital \u201cAttikon\u201d, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5662-8354","authenticated-orcid":false,"given":"Panagiotis","family":"Papadopoulos-Manolarakis","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"},{"name":"Department of Neurosurgery, General Hospital of Nikaia-Piraeus, 18454 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8523-1024","authenticated-orcid":false,"given":"Irini","family":"Chatziralli","sequence":"additional","affiliation":[{"name":"Second Department of Ophthalmology, General University Hospital \u201cAttikon\u201d, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4188-9518","authenticated-orcid":false,"given":"Vasileios","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Laboratory of Anatomy, Faculty of Medicine, Democritus University of Thrace, 69100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0050-284X","authenticated-orcid":false,"given":"Georgios","family":"Velonakis","sequence":"additional","affiliation":[{"name":"Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, 11528 Athens, Greece"},{"name":"Second Department of Radiology, General University Hospital \u201cAttikon\u201d, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4831-8005","authenticated-orcid":false,"given":"Maria","family":"Piagkou","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"ref_1","first-page":"120","article-title":"A Comprehensive Review on Oculomotor Nerve Palsy: Diagnosis and Management Strategies","volume":"19","author":"Shakor","year":"2025","journal-title":"J. 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