Abducens Nerve Palsy Associated With Pseudomeningocele After Lumbar Disc Surgery

Abstract

Clinical case report and review of the literature. To highlight the importance of including cerebrospinal fluid leak and pseudomeningocele in the differential diagnosis in a patient presenting with diplopia due to abducens palsy after spine surgery and to highlight the possibility of cure after successful surgical repair of the dural defect. Abducens nerve palsy after spine surgery is extremely rare, with only 3 reported cases in the literature. We report the first case of abducens nerve palsy associated with a clinically evident pseudomeningocele, which was completely cured by successful repair of the dural defect. A 53-year-old male patient with diabetes presented 6 weeks after lumbar disc surgery with persistent headache, a fluctuant swelling at the operated site, and diplopia secondary to left abducens nerve palsy. Clinical examination revealed a left abducens nerve palsy and magnetic resonance imaging showed a pseudomeningocele due to dural tear at L4-L5. He underwent exploration, and the dural defect was repaired using 6-0 Vicryl and reinforced with a fibrin sealant. After dural closure, pseudomeningocele and headache resolved completely and diplopia improved partially. At 4-week follow-up, there was complete resolution of diplopia. Clinical examination showed full recovery of the lateral rectus function, indicating resolution of the abducens palsy. Magnetic resonance imaging showed complete resolution of pseudomeningocele. Although uncommon, abducens nerve palsy after cerebrospinal fluid leak should be considered in the differential diagnosis of diplopia developing in a patient who has undergone spine surgery. After confirmation of pseudomeningocele radiologically, early surgical intervention with repair of the dural defect can result in complete recovery of the abducens nerve palsy.