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

Authors

DOI:

https://doi.org/10.12809/hkjo-v26n1-318

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. DOI: https://doi.org/10.1007/s10384-007-0489-3

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. DOI: https://doi.org/10.1007/s11910-016-0671-4

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. DOI: https://doi.org/10.1016/j.ophtha.2003.05.024

Razek AA, Huang BY. Lesions of the petrous apex: classification and findings at CT and MR imaging. Radiographics 2012;32:151-73. DOI: https://doi.org/10.1148/rg.321105758

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. DOI: https://doi.org/10.1097/WNO.0000000000000313

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Published

2022-06-29

Issue

Section

Case Report

How to Cite

1.
Diagnostic pitfall of progressive isolated abducens nerve palsy: a report of two cases. Hong Kong J Ophthalmol [Internet]. 2022 Jun. 29 [cited 2026 Aug. 16];26(1). Available from: https://hkjo.hk/index.php/hkjo/article/view/318

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