Diagnostic pitfall of progressive isolated abducens nerve palsy: a report of two cases

Authors

  • Noel Ching Yan Chan FRCSEd (Ophth), FHKAM(Ophth) https://orcid.org/0000-0002-6473-4578
  • Venice S.W. Li MBChB
  • Andy C. O. Cheng FRCOphth, FRCSEd (Ophth)
  • Tom C. Y. Cheung FRCR
  • Sherman S. M. Lo FRCR
  • Carmen K. M. Chan FRCP, FRCOphth, FRCSEd (Ophth)

Keywords:

Abducens nerve, Cranial nerve palsy, Magnetic resonance imaging

Abstract

We describe two cases of progressive abducens nerve palsy secondary to a compressive lesion in the Dorello canal. Blood tests, lumbar puncture, nasopharyngeal examination, computed tomography, magnetic resonance imaging, and angiography were performed, but the etiology could not be identified. After consultation with a neuroradiologist, fine-cut magnetic resonance imaging along the course of the abducens nerve with gadolinium and constructive interference in steady state sequences was performed, and the diagnosis was made. In cases of small intracranial pathology, the use of thinner slices or specific sequences is suggested to better visualize the course of cranial nerves.

Author Biographies

Noel Ching Yan Chan, FRCSEd (Ophth), FHKAM(Ophth)

Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong

Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong

 

Venice S.W. Li, MBChB

Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong

Hong Kong Eye Hospital

Andy C. O. Cheng, FRCOphth, FRCSEd (Ophth)

Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong

Department of Ophthalmology, Hong Kong Sanitorium & Hospital

Tom C. Y. Cheung, FRCR

Diagnostic radiology and imaging department, Prince of Wales Hospital, Hong Kong

Sherman S. M. Lo, FRCR

Consultant radiologist Scanning Department, St. Teresa’s Hospital, Hong Kong

Carmen K. M. Chan, FRCP, FRCOphth, FRCSEd (Ophth)

Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong

Hong Kong Eye Hospital

References

Akagi T, Miyamoto K, Kashii S, Yoshimura N. Cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy. Jpn J Ophthalmol 2008;52:32-5.

Elder C, Hainline C, Galetta SL, Balcer LJ, Rucker JC. Isolated abducens nerve palsy: update on evaluation and diagnosis. Curr Neurol Neurosci Rep 2016;16:69.

Patel S, Mutyala S, Leske D, Hodge DO, Holmes JM. Incidence, associations, and evaluation of sixth nerve palsy using a population-based method. Ophthalmology 2004;111:369-75.

Razek AA, Huang BY. Lesions of the petrous apex: classification and findings at CT and MR imaging. Radiographics 2012;32:151-73.

Kontzialis M, Choudhri AF, Patel VR, et al. High-resolution 3D magnetic resonance imaging of the sixth cranial nerve: anatomic and pathologic considerations by segment. J Neuroophthalmol 2015;35:412-25.

Downloads

Published

2022-06-29

How to Cite

1.
Chan NCY, Li VS, Cheng ACO, Cheung TCY, Lo SSM, Chan CKM. Diagnostic pitfall of progressive isolated abducens nerve palsy: a report of two cases. Hong Kong J Ophthalmol [Internet]. 2022Jun.29 [cited 2022Aug.13];26(1). Available from: https://hkjo.hk/index.php/hkjo/article/view/318

Issue

Section

Case Report