Abducens Nerve Palsy and Ipsilateral Incomplete Horner Syndrome: A Significant Sign of Locating the Lesion in the Posterior Cavernous Sinus

Abstract

It is a rare combination of neurological manifestations to have abducens nerve palsy and ipsilateral incomplete

Horner's Syndrome with Abducens Nerve Palsy

“…Furthermore, incomplete Horner's syndrome without anhydrosis, as in the case reported here, indicates the involvement of the periarterial sympathetic plexus at the third angulation point [17]. To date, only 13 cases with this combination of symptoms secondary to metastatic neoplasm within the cavernous sinus have been reported [4,10-16]. Regarding the primary lesions in these cases, there were 1 small cell lung cancer [10], 1 parotid cancer [10,12], 1 breast cancer [11], 1 gastric cancer [10], 1 uterine cancer [4], 3 undetermined origins [13,14] and 3 nasopharyngeal cancers [15].…”

“…However, when both are present, it is important to localize the site of the lesion [16]. When these rare clinical features are manifested, we have to consider paratrigerminal syndrome or a lesion of the posterior cavernous sinus [1].…”

“…When these rare clinical features are manifested, we have to consider paratrigerminal syndrome or a lesion of the posterior cavernous sinus [1]. Sympathetic nerve fibers travel over the wall of the carotid artery and in the cavernous portion the fibers leave the ICA and accompany the abducens nerve for only a few millimeters in the posterior portion of the sinus [4,10,12,16] (Fig. 5).…”

“…Nasopharyngeal carcinoma can spread through the foramen lacerum and invade the cavernous sinus, resulting in cranial nerve injuries [7]. In previous reports, there have been only 13 cases of combined abducens nerve palsy and ipsilateral Horner's syndrome secondary to metastatic neoplasm within the cavernous sinus [4,10-16]. Here, we report a case with a combination of 6th nerve palsy and incomplete Horner's syndrome caused by invasive nasopharyngeal cancer in the cavernous sinus.…”

Horner’s syndrome, Pseudo-Horner’s syndrome, and simple anisocoria

“…In the cavernous sinus, the oculosympathetic fibers coalesce and run in close proximity to the sixth cranial nerve. Thus, the combination of an ipsilateral sixth nerve palsy and a postganglionic Horner's syndrome is highly suggestive of a cavernous sinus lesion [35][36][37][38]. Tsuda et al [36] reported nine patients with this clinical combination.…”