Transient recurring paralysis of ocular abduction. A syndrome of intracranial hypertension.

Abstract

Paralysis of the abducens nerve may be a consequence of intracranial hypertension of whatever cause. The vulnerability of this nerve has been ascribed to stretching and bony impingement with downward displacement of the brain stem, 1,2 to notching by branches of the basilar artery, 3 and, in a general way, to its long unprotected course. The loss of ocular abduction, which is equated with paralysis of the nerve, while subject to some variation, is usually persistent over a period of days or weeks. The opportunity to observe transient and recurring paralysis of ocular abduction in two patients suffering from intracranial hypertension has prompted this description of a phenomenon which has received limited attention in the past. 3-7 The fluctuating level of function in this condition might be explained by proposing short-lived changes in the dynamics of abducens paralysis noted above. However, the associated symptoms in one of the patients