Abducens nerve palsy: A sole presentation of isolated cerebellar tuberculoma

Abstract

Tuberculomas constitute 5–30% of the space-occupying lesions of the central nervous system (CNS) in developing countries, and children and young adults are the most affected population. Most CNS tuberculomas include focal neurological signs with evidence of either meningeal exudates or hydrocephalus, but presentation as isolated sixth nerve palsy is very rare. We report a case of an immunocompetent female who presented with double vision, and was found to have isolated abducens nerve palsy of the right eye. On magnetic resonance imaging of the brain, solitary cerebellar tuberculoma was identified without any evidence of meningitis, basal exudate, or hydrocephalus. Despite the prompt initiation of anti-tubercular drugs and steroids, negligible improvement was noticed at 2 weeks of follow-up. This report highlights that isolated tuberculoma of any unrelated brain region can cause lateral rectus palsy, which may result in permanent disability.