abducens palsy
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Cureus ◽  
2022 ◽  
Saurabh Kumar ◽  
Bharat Seju ◽  
Durga Shankar Meena ◽  
Arjun Kachawaha ◽  
Maya Gopalakrishanan

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S14.1-S14
Kyle R. Marden ◽  
James E. Siegler ◽  
David Gealt

ObjectiveTo highlight a multidisciplinary approach to the diagnosis and management of unilateral abducens palsy after a sports-related concussion.BackgroundMild traumatic brain injury (TBI) often leads to disruptions in visual functioning, affecting convergence, saccades, smooth pursuit, and accommodation. More severe TBI injuries may result in structural injuries to the ocular muscles, nerves, or the brain itself.Design/MethodsNA.ResultsCase: We present the case of a 33-year-old male with unilateral abducens nerve palsy after a sports-related concussion with loss of consciousness and multiple hemorrhagic contusions. The patient's visual symptoms manifested several days after the injury. With a multi-disciplinary evaluation involving specialists representing neurosurgery, endovascular neurology and neuro-ophthamology, unenhanced magnetic resonance imaging revealed multiple foci of intraparenchymal microhemorrhages and siderosis consistent with diffuse axonal injury (DAI), and an incidental parasagittal cavernoma. The delayed development of a sixth nerve palsy raised our suspicion for secondary axotomy, as has been described following TBI. While the probability of recovery is high, close follow up is imperative to address evolution of the patient's symptoms. In this case, the patient developed imbalance and headaches in association with his visual symptoms. For the imbalance we use physical therapy with therapists trained in vestibular therapy and for the visual symptoms we use vision therapy with trained optometrists.ConclusionsDelayed post-traumatic abducens palsy is concerning for DAI and secondary axotomy. Multidisciplinary assessment imparts the ability to evaluate for all possible causes and provide additional specialized care for recovery.

2021 ◽  
Vol 12 (10) ◽  
pp. 164-170
Sandeep B V ◽  
Rekha K R ◽  
Manpreet Singh Banga ◽  
Anantha Kishan ◽  
Vittal I Nayak ◽  

Isolated bilateral sixth nerve palsies are rare, particularly in the setting of trauma. Most post-head injury cases with bilateral abducens palsy involve either basal skull fractures, particularly clival fractures. We present a case of bilateral abducens palsy after closed head injury in a young male who presented to the emergency department and a comprehensive literature review based on our clinical case. A Medline search for bilateral abducens palsy in closed head injury showed 89 results. Articles were excluded if crush head injury, non-traumatic bilateral abducens nerve palsy, associated vascular malformations were reported. After thorough search and filtering of those articles, fifty-one publications were found which reported and discussed about traumatic bilateral abducens palsy with closed head injury. In these 51 articles, a total of 139 cases were recorded. Several theories have been postulated to explain mechanisms of abducens nerve injury in trauma both in immediate and delayed settings. In our case, patient presented with immediate onset of bilateral abducens palsy. On imaging, clival fracture was seen in CT brain, which can be attributed for the nerve injury. Cases with retroclival extradural haematoma had higher chances of multiple cranial nerve injuries. Cases with multiple basal skull fracture involving petrous temporal bone fracture had higher chances of facial nerve injury. Along with bilateral involvement, the poorer outcome for recovery can be related with the severity of the adduction deficit. Our case showed no improvement in bilateral abduction during follow-up at 6 months. Clinical presentation of traumatic bilateral abducens nerve palsy is rare following closed head trauma and is usually associated with other injuries which are incompatible with life. It can be associated with other nerve injuries depending on basal skull fractures.

Maya Aldeeb ◽  
Mohamed Samara ◽  
Samreen Oraiby ◽  
Faraj Howady ◽  
Satya Patro ◽  

We are reporting a COVID-19 positive patient who developed diplopia and was found to have an isolated abducens palsy. We reviewed the available English literature of cranial mononeuropathy as a possible manifestation of COVID-19 infection.It is a rare presentation of COVID-19.

2021 ◽  
pp. 014556132110303
Noah Shaikh ◽  
Anthony Leonard ◽  
Caitlyn Patton ◽  
SoHyun Boo ◽  
John Nguyen ◽  

Significance Statement This case report demonstrates a novel approach to treating a rare indirect carotid cavernous fistula (CCF) and associated abducens palsy. Although endovascular treatment is the standard of care in the management of CCFs, it was contraindicated in this patient. Instead, she underwent an endoscopic endonasal approach (EEA) with decompression of the medial orbital apex, including the cavernous sinus and optic nerve, with complete resolution of headache, lateral gaze palsy, and diplopia within 2 months.

2021 ◽  
Vol 9 (1) ◽  
pp. 09-11
Tamara Quint ◽  
Christian Jantschitsch ◽  
Harald Maier

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