Case Of Abducens Nerve Palsy Research Articles

Abducens Nerve Palsy Caused by Cavernous Sinus Meningioma Mimicking Tolosa-Hunt Syndrome

Purpose: To report a case of abducens nerve palsy caused by cavernous sinus meningioma mimicking Tolosa-Hunt syndrome (THS).Case summary: A 59-year-female visited to the ophthalmic department for sudden onset of horizontal diplopia for 20 days. The extraocular examination showed 10 prism diopters (PD) esotropia at distant fixation and ortho at near fixation without definitive abduction limitation. At 2 months of follow-up, she showed the 25 PD left esotropia with abduction limitation of the left eye. The ocular pain and headache were newly developed. Magnetic resonance imaging (MRI) with contrast was performed and revealed the enlargement and enhancement of left cavernous sinus. THS was suspected and high dose steroid treatment was performed. The ocular findings and headache were improved after treatment. These symptoms showed waxing and waning with steroid tapering during follow-up. The follow-up MRI showed no definitive improvement of cavernous sinus lesion compared with previous study. The cavernous sinus meningioma was considered. There was no improvement of ocular motility findings during follow-up and the strabismus surgery was performed.Conclusions: The abducens nerve palsy with headache can occur caused by cavernous sinus meningioma. It may be difficult to differentiate it from THS in certain cases.

A Case of Abducens Nerve Palsy and Subretinal Fluid Related to Idiopathic Intracranial Hypertension in Androgen Insensitivity Syndrome.

A Case of Abducens Nerve Palsy and Subretinal Fluid Related to Idiopathic Intracranial Hypertension in Androgen Insensitivity Syndrome.

A Case of Abducens Nerve Palsy Caused by Sinusitis Indistinguishable from Diabetic Ophthalmoplegia

[Introduction] Cranial nerve palsies can occur as a complication of several diseases, such as diabetes mellitus, aneurysm, and sinusitis. We have encountered many cases in which we successfully identified the cause of the cranial nerve palsy, but later also found an additional etiologic factor. Thus, even in a patient with sinusitis developing a cranial nerve palsy, the palsy could be caused by a disease other than sinusitis.

Clinical Course of Abducens Nerve Palsy in Patients with Ruptured Vertebral Artery Dissecting Aneurysms.

There are few detailed reports on abducens nerve palsy due to a ruptured vertebral artery dissecting aneurysm (VADA). We investigated the clinical characteristics and long-term course of abducens nerve palsy in ruptured VADA patients treated by endovascular surgery. Of the 51 cases of ruptured VADA treated by endovascular intervention from 2011 to 2019, 31 with a good/fair outcome, in which ocular motility disorder was able to be followed, were included and investigated. In all, 11 patients (35.5%) had abducens nerve palsy, and the World Federation of Neurological Surgeons (WFNS) grade and Hunt & Hess (H&H) grade at the time of arrival of patients with abducens nerve palsy were significantly higher than those of patients without abducens nerve palsy. Of the 10 patients who were able to be followed, abducens nerve palsy in 3 completely recovered in 7-180 days. Abducens nerve palsy improved in five patients and remained in two patients. More severe neurological findings on admission reflect a higher rate of abducens nerve palsy. Diplopia induced by abducens nerve palsy is one of the most important sequelae of ruptured VADA, which impairs the daily activities of the patients. Some cases of abducens nerve palsy improve over a long period. Therefore, appropriate diagnosis and follow-up should be concerned.

P.156 Outcomes of Cranial Nerve Deficits in Patients with Pituitary Apoplexy: The Ottawa Hospital Experience

Background: One of the rare but urgent presentations of a pituitary tumor is pituitary apoplexy. In this case series, we describe our experience regarding the cranial nerve recovery in patients with pituitary apoplexy following endoscopic endonasal transsphenoidal surgery (EETS). Methods: Retrospective cohort study with patient characteristics, tumor type, endocrine data, operation data collected. Postoperative data were extracted for the follow-up period available for each patient. Results: 15 pituitary apoplexy cases were identified. The cranial nerve deficits presented at admission were: visual deficit (33% patients); unilateral third nerve palsy (47% patients), unilateral sixth nerve palsy (27% patients). Postoperatively, 60% of patients with preoperative visual deficit had normal visual fields and the other 40% showed improvement. From those with oculomotor nerve dysfunction preoperatively, 43% have returned to normal nerve function and 57% presented improvement. 75% cases of abducens nerve palsy resolved postoperatively, while 25% showed improvement. Conclusions: Based on this series, surgical treatment should be offered to patients presenting with cranial nerve deficit in the setting of pituitary apoplexy. In this series, all cranial nerve deficits either returned to normal or improved following surgery. Though a small series, the presented results are superior to those reported in the literature for conservative management.

Acute Myeloid Leukemia Revealed by Abducens Nerve Palsy: About One Case

Abducens palsy in case of acute myeloid leukemia is the result of infiltration of meninges. We report a case of Abducens nerve palsy revealing acute myeloid leukemia. Materials and Methods: A 49 year old female patient was admitted at consultation of ophthalmology in the military hospital Moulay Ismail of Meknes, this patient has an acute diplopia with general asthaenia. Results: The screening has revealed an abducens nerve palsy confirmed by Lancaster test. The MRI showed homogenous infiltration of cerebello pontine angle by an enhanced materiel. A bone marrow specimen was hypercellular without fibrosis. Discussion: Abducens palsy as first sign of an acute myeloid leukemia is rare. In our patient, it seems to be in relation with cerebello pontine angle infiltration as shown by MRI .Curative treatment is based on intensive chemotherapy. Conclusion: Abducens palsy as revealing sign of acute myeloid leukemia is rare.

Intracranial complication of rhinosinusitis from actinomycosis of the paranasal sinuses: a rare case of abducens nerve palsy.

Sinonasal actinomycosis should be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, cancer, immunodeficiency, long-term steroid therapy, diabetes, or malnutrition. Radiological evaluation with computed tomography and magnetic resonance imaging are important in differential diagnosis, evaluating the extent of disease, and understanding clinical symptoms. Endoscopic sinus surgery associated with long-term intravenous antibiotic therapy is the gold standard for treatment of sinonasal actinomycosis. We report an unusual case of abducens nerve palsy resulting from invasive sinonasal actinomycosis in a patient with an abnormally enlarged sphenoid sinus. A review of the current literature highlighting clinical presentation, radiological findings, and treatment of this uncommon complication is also presented.

Ossification of the petrosphenoidal ligament: unusual variation with the potential for abducens nerve entrapment in Dorello’s canal at the skull base

Variable bony anatomy at the skull base may result in compression or entrapment of exiting cranial nerves. The authors present an unusual variation of bilateral ossification of the roof of Dorello's canal and review the germane literature. Clinicians might consider ossification of the petrosphenoidal ligament (also called Gruber's ligament) in patients with unexplained cases of abducens nerve palsy.

Abducens palsy after lumbar drain placement

To study reports of abducens nerve palsy following dural puncture procedures and to discuss possible etiologic theories, treatment, and prognosis. Systematic review of peer-reviewed literature. A systematic literature review was conducted (PubMed, 1950 to September 2011) for cases of sixth cranial nerve palsy following dural puncture procedures. We report a case of abducens nerve palsy following lumbar drain placement for endoscopic trans-sphenoidal pituitary macroadenoma resection. Sixth nerve palsy was noted immediately after surgery. Postoperative computed tomography and magnetic resonance imaging revealed no injury to the nerve or surrounding structures. A systematic literature review conducted for cases of abducens nerve palsy following dural puncture procedures found 22 studies (17 case reports and five case series). Twenty-eight patients with temporary or permanent abducens nerve palsy were reported. Procedures included diagnostic lumbar puncture, spinal anesthesia, intrathecal catheterization, and shunting. Traction and local ischemia due to intracranial hypotension at the petroclival junction were proposed as causes of palsy. Lumbar puncture procedures carry a rare risk of abducens nerve palsy from ischemic or traction injury. Routine use of lumbar drain during endoscopic skull base surgery is not without risk, and need for its placement should be carefully determined. Knowledge of such rare complications is helpful in risk-benefit analysis as endoscopic skull base techniques gain popularity.

A Case of Abducens Nerve Palsy after Percutaneous Nerve Block for Trigeminal Neuralgia

A Case of Abducens Nerve Palsy after Percutaneous Nerve Block for Trigeminal Neuralgia

Paralytic squint due to abducens nerve palsy : a rare consequence of dengue fever

BackgroundDengue fever is an endemic illness in the tropics with early and post infectious complications affecting multiple systems. Though neurological sequelae including mononeuropathy, encephalopathy, transverse myelitis, polyradiculopathy, Guillain-Barre syndrome , optic neuropathy and oculomotor neuropathy have been reported in medical literature, the abducens nerve despite its notoriety in cranial neuropathies in a multitude of condition due to its long intracranial course had not been to date reported to manifest with lateral rectus paralysis following dengue.Case presentationA previously well 29 year old male with serologically confirmed dengue hemorrhagic fever developed symptomatic right lateral rectus palsy during the critical phase of the illness, which persisted into convalescence and post convalescence with proven deficit on Hess screen. Alternate etiologies were excluded by imaging, serology and electrophysiology.ConclusionsThe authors detail the first reported case of abducens nerve palsy complicating dengue fever in a previously healthy male from Sri Lanka. In a tropical country with endemic dengue infections, dengue related abducens neuropathy may be considered as a differential diagnosis in cases of acquired lateral rectus palsy after dengue fever.

Abducens Nerve Palsy Following Lumbar Subarachnoid Drain Placement: A Case Report and Review of the Literature

Introduction: Abducens nerve palsy is a rare complication following lumbar dural puncture for spinal anesthesia, diagnostic cerebrospinal fluid (CSF) analysis, and lumboperitoneal shunting. We describe the first known case of abducens nerve palsy from lumbar subarachnoid drain placement during pituitary macroadenoma resection.

Abducens Nerve Palsy Associated With Pseudomeningocele After Lumbar Disc Surgery

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.

Diplopia Following Spine Surgery: A Case Series

Introduction: Cranial traction leading to 6th nerve palsy is the main cause of developing diplopia following spinal surgery. Very few cases of abducens nerve palsy as a complication of surgery without cranial traction have been described. We review a series of four patients who developed diplopia following spinal surgery only one of which had cranial pins or apparent traction on the abducens nerve. Case presentations: Case 1, a 14-year-old girl who had a posterior segmental instrumentation correction and fusion under general anesthesia in the prone position. Case 2, a 34 year old woman who had posterior fusion and fixation. Case 3, a 67 year-old woman who had a C5-C6, C6-C7 anterior cervical diskectomy and fusion procedure. Cranial traction was util- ized. Case 4, an 18 year-old woman who had an anterior interbody spinal fusion. All cases developed facial edema and diplopia on the first day postoperatively. Conclusion: Diplopia is a rare complication following spine surgery. It needs special attention as it can be attributed to several reasons. Facial edema, face traction and CSF leakage were the possible reasons in our cases. Diplopia was tempo- rary and resolved spontaneously in all our cases.

추체골염을 동반하지 않는 급성 유양돌기염에 의한 외전신경마비 1예

A 29-month-old boy presented with acute onset of esodeviation and limitation of ocular movement in his right eye. He had a history of right otitis media for 6 weeks, was diagnosed as abducens nerve palsy. Ventilation tube insertion was done after the eye symptom developed. At first day after surgery, esotropia of 30 prism diopters (PD) and abduction limitation (-4) was still obseved in the right eye due to abducens nerve palsy of the right side. A computed tomography of the temporal bone and magnetic resonance imaging of the brain showed severe mastoiditis without involvement of the abducens nerve pathway including petrous bone. At 6 days after onset of esotropia, simple mastoidectomy was done. An esotropia was improved gradually and at 4 months after surgery, orthotropia and normal ocular movement were acquired. We report a rare case of abducens nerve palsy presumed to be complicated by septic thrombosis of inferior petrosal sinus from mastoiditis without petrous apicitis. (J Clinical Otolaryngol 2010;21:74-78)

Orbitoethmoidal impacted injury by kitchen knife causing abducens nerve palsy

Impacted knife injuries in the maxillofacial region are rare and infrequently reported. In cases of injury involving orbit or eye, these reports are even rarer. Damage to the orbital contents may result in a rupture of the globe, extraocular muscle injury, lacrimal gland damage, and others. Orbital foreign bodies are not only difficult to detect, and clinical features vary according to its size, characteristics, shape, penetrating method, and site. In this report, a case of abducens nerve palsy after orbitoethmoidal knife injury is presented.

Abducens Nerve Palsy after Lumbar Spinal Fusion Surgery with Inadvertent Dural Tearing

Abducens nerve palsy associated with spinal surgery is extremely rare. We report an extremely rare case of abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing, which resolved spontaneously and completely. A 61-year-old previous healthy man presented with chronic lower back pain of 6 weeks duration and 2 weeks history of bilateral leg pain. He was diagnosed as having isthmic spondylolisthesis at L4-5 and L5-S1, and posterior lumbar interbody fusion was conducted on L4-5 and L5-S1. During the operation, inadvertent dural tearing occurred, which was repaired with a watertight dural closure. The patient recovered uneventfully from general anesthesia and his visual analogue pain scores decreased from 9 pre-op to 3 immediately after his operation. However, on day 2 he developed headache and nausea, which were severe when he was upright, but alleviated when supine. This led us to consider the possibility of cerebrospinal fluid leakage, and thus, he was restricted to bed. After an interval of bed rest, the severe headache disappeared, but four days after surgery he experienced diplopia during right gaze, which was caused by right-side palsy of the abducens nerve. Under conservative treatment, the diplopia gradually disappeared and was completely resolved at 5 weeks post-op.

Abducens Nerve Palsy Induced by Chemotherapeutic Agents

Purpose: To report two cases of abducens nerve palsy that occurred after the administration of chemotherapeutic agents. Case summary: (Case 1) A 49-year-old woman with breast cancer presented with acute onset of diplopia 6 weeks after the beginning of combination chemotherapy with cyclophosphamide, doxorubicin, and paclitaxel. She had a left esotropia of 30 prism diopters (PD) with a mild decrease in abduction of the left eye. She was diagnosed with left abducens nerve palsy. (Case 2) A 29-year-old man with non-Hodgkin’s lymphoma presented with diplopia 7 weeks after beginning combination chemotherapy including cyclophosphamide, adriamycin, vincristine, and prednisolone. He had a 20PD esotropia in the primary position with a slight decrease in abduction of both eyes. He was diagnosed with bilateral abducens nerve palsy. The chemotherapy regimen of both patients was changed, and they were followed up without treatment. In case 1, diplopia improved 2 months after change of chemotherapy regimen with complete recovery within 4 months. In case 2, diplopia improved 2 months after a change of chemotherapy regimen with complete recovery within 3 months.

A Case of Abducens Nerve Palsy and Disc Swelling Complicating Pregnancy-Induced Hypertension

Purpose: Abducens nerve palsy complicating pre-eclampsia during pregnancy occurs very rarely. The authors describe right abducens nerve palsy, disc swelling, and hypertensive retinopathy found in both eyes of a pre-eclampsia patient. Case summary: A 29-year-old woman, who was in her 31st week of gestation, was admitted to the hospital complaining chiefly of diplopia and abduction limitation in her right eye, which started suddenly 3 weeks prior to admission. Her condition was carefully followed up by a local clinic because this symptom of hypertension manifested one month before her admission to the local clinic. Brain MRI and laboratory tests were performed in order to exclude diseases of the central nervous system and/or other systemic diseases. An alternative prism cover test showed approximately 25PD (prism diopter) right esotropia, with -2 degrees abduction limitation observed in the patient's right eye. Both hypertensive retinopathy and papilledema were observed. Her blood pressure was 155/110 mmHg, and she had moderate proteinuria when she was admitted to the hospital. She was referred to an obstetrician and diagnosed as having pre-eclampsia. Other than pre-eclampsia with proteinuria, the brain imaging examination failed to reveal any particular findings, such as CNS disorders, including brain edema, cerebral infarction, or a brain tumor. In addition, systemic diseases which might have caused papilledema and abducens nerve palsy, including diabetes mellitus, were not evident in this case. Therefore, the patient was diagnosed with ischemic abducens nerve palsy and hypertensive retinopathy complicating moderate pre-eclampsia. The patient’s diplopia and right eye abduction limitation were gradually relieved after parturition.

Abducens Nerve Palsy As a Complication of Spinal Anesthesia Following Knee Arthroscopy

Neuroaxial blocks (spinal, epidural and caudal blocks) are commonly used procedures in anesthesia. Dural puncture was first introduced by Quincke. Bier proposed that leakage of cerebro spinal fluid (CSF) through the dural puncture side exceeds the rate of CSF production and results in low CSF pressure. This leads to intracranial hypotension causing traction of the cranial nerves(1,2). The nervus abducens is most frequently affected because of its long intracranial course(2). We report a case of abducens nerve palsy following spinal anesthesia.