A case report of isolated abducens nerve palsy: idiopathic or ophthalmoplegic neuropathy?

Abstract Background Abducens nerve is the most common nerve affected among other cranial nerves in terms of isolated ocular palsy. Despite its prevalence and progression made in neuroimaging, incidence of idiopathic cases continues to rise. Case presentation We report a young adult male with no previous illnesses, who presented with sudden onset of binocular diplopia and headache and was later diagnosed with an isolated ipsilateral abducens nerve palsy secondary to an unknown cause and treated with steroids. The palsy and diplopia had resolved in 2-month time but the patient still continued to suffer from a migraine, such as headache. Conclusion Although, we labelled the patient as idiopathic initially, another plausible cause for this kind of presentation could be recurrent painful ophthalmoplegic neuropathy (RPON) owing to the nature of the presentation. Cases labelled as idiopathic could be attributed to a defined pathogenesis with detailed history and follow-up. Follow-up is vital for all patients, especially those labelled as idiopathic as recurrence of the illness have the chance of changing the diagnosis if supported by the detailed history and physical examination findings.

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Abducens nerve palsy on a patient with sphenoid fungal rhinosinusitis and cavernous sinus meningioma – Case report

Romanian Journal of Rhinology ◽

10.2478/rjr-2018-0022 ◽

2018 ◽

Vol 8 (31) ◽

pp. 193-196

Author(s):

Andreea Marza ◽

Claudiu Manea

Keyword(s):

Cavernous Sinus ◽

Nerve Palsy ◽

Abducens Nerve ◽

Complete Removal ◽

Abducens Nerve Palsy ◽

Cavernous Sinus Meningioma ◽

Fungal Rhinosinusitis ◽

Wait And See ◽

The Brain

Abstract We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery. The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.

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Bilateral traumatic paralysis of abducent nerves and clivus fracture: Case Report

Romanian Neurosurgery ◽

10.2478/romneu-2014-0070 ◽

2014 ◽

Vol 21 (4) ◽

pp. 507-509

Author(s):

Willen Guillermo Calderon-Miranda ◽

Hernando Raphael Alvis-Miranda ◽

Gabriel Alcala-Cerra ◽

Luis Rafael Moscote-Salazar

Keyword(s):

Nerve Palsy ◽

Cranial Nerves ◽

Rectus Muscle ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Traumatic Injuries ◽

Cranial Trauma ◽

Lateral Rectus Muscle ◽

Clivus Fracture ◽

Bilateral Abducens

Abstract Clivus fractures are a rare pathology, frecuently associated tohigh power trauma. Such injuries may be associated with vascular and cranial nerves lesions. The abducens nerve is particularly vulnerable to traumatic injuries due to its long intracranial course, since their real origin until the lateral rectus muscle. The unilateral abducens nerve palsy of 1- 2-7% occurs in patients with cranial trauma, bilateral paralysis is rare. We report a patient who presented bilateral abducens nerve palsy associated with a clivus fracture

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Bilateral Abducens Nerve Palsy and the possible Association with COVID-19: A Case Report

Archives of Medical Case Reports and Case Study ◽

10.31579/2692-9392/078 ◽

2021 ◽

Vol 4 (4) ◽

pp. 01-03

Author(s):

Abdulla Abu Hantash ◽

Mohammed Abu Safieh ◽

Salam Iriqat ◽

Mohammad Daraghmeh

Keyword(s):

Case Report ◽

Nerve Palsy ◽

Cranial Nerves ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Nasopharyngeal Swab ◽

Upper Respiratory Tract ◽

History Of ◽

Upper Respiratory ◽

Bilateral Abducens

Cranial nerve neuropathy could be a part of neurological spectrum of COVID-19 disease. Research suggests SARS-CoV-2 infection can trigger an aberrant immune response in some individuals, causing inflammatory nerve damage leading to anosmia and neuropathy. We report here a 50-year-old female patient who presented to the outpatient clinic in Saint John Eye Hospital with a two months history of binocular, horizontal diplopia five days after recovery from SARS-CoV-2 infection, PCR positive test obtained by a nasopharyngeal swab on April 1st, 2021 with upper respiratory tract symptoms. The patient was diagnosed with bilateral abducens nerve palsy. The main cause was presumed to be post-viral as the patient had controlled diabetes “HBA1C: 7%” and had no pre-existing microvascular risk factors. Diplopia still exists after two months of bilateral abducens nerve palsy. Measurements confirmed bilateral limited abductions in both eyes with right or alternating convergent squint. This case report supports the hypothesis that direct or indirect virally mediated injuries along the routes of the cranial nerves can cause neuropathy and olfactory dysfunction. The longer latency effects of COVID-19 infection are not well understood. This case report aims to raise awareness amongst clinicians of coronavirus-induced neurological symptoms

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Isolated abducens nerve palsy associated with coronavirus disease: an 8-month follow-up

Arquivos Brasileiros de Oftalmologia ◽

10.5935/0004-2749.20220063 ◽

2022 ◽

Vol 85 (5) ◽

Author(s):

Analine Lins de Medeiros ◽

Thayze Martins ◽

Marisa Kattah ◽

Ana Karine A. Soares ◽

Liana O. Ventura ◽

...

Keyword(s):

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy

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Differential Diagnosis of Acquired Esotropia in the Elderly

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1186-2029 ◽

2020 ◽

Vol 237 (09) ◽

pp. 1107-1116

Author(s):

Bettina Roggenkämper ◽

Antje Neugebauer ◽

Julia Fricke ◽

Andrea M. Hedergott

Keyword(s):

Nerve Palsy ◽

Abducens Nerve ◽

The Elderly ◽

Sudden Onset ◽

Neurological Symptoms ◽

Abducens Nerve Palsy ◽

Double Vision ◽

Unaffected Side ◽

Primary Position ◽

The Individual

Abstract Aim To provide an overview of the differential diagnoses of acquired esotropia that occur in the elderly and to facilitate their differentiation in everyday clinical practice. Methods The data of all patients who presented in our outpatient university department for strabology and neuroophthalmology from March 2014 to October 2015 due to esotropia with diplopia with onset after age 50 were evaluated retrospectively. Exclusion criteria were a known strabismus before the age of 50 and/or vertical deviations in the primary position. Anamnestic characteristics, accompanying findings and orthoptic parameters, were analysed. Results 85 patients were included in the study, 42 of them female and 43 male. The following diagnoses were made: abducens nerve palsy (n = 34, 3 of them both sides), esotropia due to myopia magna (n = 12), esotropia with accompanying neurological symptoms (n = 6) and other etiology (n = 5). In 4 cases, the diagnosis was still unclear at the end of the study. In 24 patients, none of the above diagnoses existed and the diagnosis of “sagging eye syndrome” (ETSAG) was made. The abducens nerve palsy typically showed a sudden onset of double vision, slowed abduction saccades and asymmetrical abduction ability. With unilateral abducens nerve palsy, the esotropia increased continuously from the view to the unaffected side through the primary position to the view to the affected side. Patients with ETSAG and myopia-associated esotropia, on the other hand, reported a gradual onset of double vision, showed normal abduction saccades and a slightly reduced abduction ability. The squint angle often increased slightly to both sides. Esotropia with accompanying neurological symptoms was rare and was seen in various underlying diseases. Conclusions The kind of onset of the double vision, the quality of the saccades, the incomitance pattern and the ability to abduct are important parameters for the etiological assignment of an esotropia in the elderly. The characteristics of the individual diagnoses are described and differential diagnostic aspects are discussed.

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Long-term follow-up of children with benign abducens nerve palsy

Eye ◽

10.1038/eye.2009.22 ◽

2009 ◽

Vol 24 (1) ◽

pp. 74-78 ◽

Cited By ~ 7

Author(s):

V Sturm ◽

C Schöffler

Keyword(s):

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Long Term Follow Up

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Two cases of benign abducens nerve palsy in children and their long-term follow-up

Journal of International Medical Research ◽

10.1177/0300060520986702 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098670

Author(s):

Tong Zhang ◽

Jihong Tang

Keyword(s):

Nerve Palsy ◽

Gamma Globulin ◽

Clinical Symptoms ◽

Abducens Nerve ◽

Diagnostic Methods ◽

Abducens Nerve Palsy ◽

Long Term Follow Up ◽

Laboratory Examinations

Our aim was to explore the clinical characteristics and diagnostic methods of benign abducens nerve palsy in children. The clinical and laboratory characteristics, treatment approach, and prognosis of two children with benign abducens nerve palsy were retrospectively evaluated. The main clinical symptoms of the two children were limited binocular movement accompanied by double vision, and the positive physical signs were limited binocular abduction accompanied by diplopia. No abnormalities were found in laboratory examinations or in imaging of the head, chest, and abdomen. Both children were treated with B vitamins, methylprednisolone, and gamma globulin, and the clinical symptoms disappeared within 3 months of starting treatment. The cause of benign abducens nerve palsy in children is unknown, but may be related to immune factors. In the two cases presented here, the patients recovered after treatment with immunomodulators.

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