Abducens nerve palsy in spontaneous intracranial hypotension

Berlit, Peter; Berg-Dammer, E.; Kuehne, D.

doi:10.1212/wnl.44.8.1552

Cited by 38 publications

(18 citation statements)

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“…In cases of intracranial hypotension with brainstem sag or cervical trauma resulting in parenchymal movement within the cranium, this may be a point at which the cisternal segment of the nerve suffers stretch injury. 9 Ozveren et al 27 point out that fixation of the nerve to the lateral wall of the cavernous ICA may also be a mechanism for abducent nerve injury in trauma. An autopsy analysis after severe head trauma demonstrated frequent contusion at this site and at the dural porus.…”

Section: Discussionmentioning

confidence: 99%

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

Kshettry

Lee

Ammirati

2013

FOC

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Interest in studying the anatomy of the abducent nerve arose from early clinical experience with abducent palsy seen in middle ear infection. Primo Dorello, an Italian anatomist working in Rome in the early 1900s, studied the anatomy of the petroclival region to formulate his own explanation of this pathological entity. His work led to his being credited with the discovery of the canal that bears his name, although this structure had been described 50 years previously by Wenzel Leopold Gruber. Renewed interest in the anatomy of this region arose due to advances in surgical approaches to tumors of the petroclival region and the need to explain the abducent palsies seen in trauma, intracranial hypotension, and aneurysms. The advent of the surgical microscope has allowed more detailed anatomical studies, and numerous articles have been published in the last 2 decades. The current article highlights the historical development of the study of the Dorello canal. A review of the anatomical studies of this structure is provided, followed by a brief overview of clinical considerations.

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Section: Discussionmentioning

confidence: 99%

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

Kshettry

Lee

Ammirati

2013

FOC

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“…Thus spinal procedures like lumbar puncture, contrast myelography, spinal anesthesia, and spinal shunting have been reported to cause abducens paralysis (8,23,26,32,42). Abducens paralysis may also result from iatrogenic and spontaneous intracranial hypotension (6,7,10,22). Intracranial hypertension, intracranial hypotension and cerebrospinal fluid withdrawal all share a common element; all result in downward displacement of the brain stem which in turn stretches the abducens nerve against its angles and fixations at the petrous apex.…”

Section: Discussionmentioning

confidence: 99%

Microanatomical study of the intracranial abducens nerve: clinical interest and surgical perspective

Özer¹,

Içke²,

Arda³

2010

Turkish Neurosurgery

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AIM:The microanatomy of the abducens nerve (AN) is important for clinical reasons and surgical approaches as it is located in the petroclival region. The incidence of branching and duplication of the abducens nerve are unknown and mechanisms relating to paralysis of the nerve in indirect conditions are yet to be clarified. MATeRIAL and MeTHodS:Microanatomical details (anatomical observations and morphometric measurements) of the AN were obtained from 20 cadaveric skull bases (40 specimens). ReSULTS: 55% of the intracranial abducens nerves had branching, with type 2 and 3 branching occurring in 10%. The nerve coursed below the petrosphenoidal ligament in all but one, and was located at the lateral third below the ligament in 82.5% of the specimens. The mean AN diameter was 1.3±0.2 mm, and the mean diameter of the dural entrance pore was 1.8±0.3 mm, the right being significantly larger than the left. The mean distance of the AN from the posterior clinoid process was 8.4±2.5 mm and from the petrous apex 3.6±2.1 mm. CoNCLUSIoN: Branching of the AN was present in a significant number of specimens; the branching pattern at the cavernous segment may be called "pseudobranching". The AN is at risk for paresis in indirect conditions because of its angles and fixations on its course.

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“…The abducens nerve is more likely to be susceptible to traction-related injury secondary to its long intracranial course along the clivus and through the Dorello canal, as well as its attachment to the Gruber ligament. 8,22 Although less common, both unilateral and bilateral paresis of the third and fourth cranial nerves has also been noted to occur with spontaneous ICH. 10,15,16,28,33,40,41 Once again, in the majority of cases these findings have been reported to reverse completely following resolution of the CSF leak.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10]13,[16][17][18][19][20][22][23][24][25][26][27][28]30,32,33,36,40,41 The majority of patients (35 [83%]) with reported ophthalmoplegia presented with abducens nerve palsies. Unilateral abducens nerve palsies were reported in 25 patients (60%), whereas 10 patients were reported to have bilateral abducens nerve palsies (24%).…”

Section: Ophthalmoplegia Due To Cranial Nerve Dysfunction In Ichmentioning

confidence: 99%

A review of ocular manifestations in intracranial hypotension

Zada

Solomon²,

Giannotta³

2007

FOC

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Object Intracranial hypotension (ICH) can present with a wide variety of visual symptoms and findings. Deficits in visual acuity and visual fields as well as ophthalmoplegia due to cranial nerve dysfunction have been frequently described. The aim of this review was to identify the most commonly reported ocular manifestations associated with ICH. Methods The authors conducted a review of the literature to date to identify all studies of patients with ICH and ocular manifestations. Results The most commonly encountered cranial nerve deficit resulting from ICH (> 80% of reported cases) is an abducens nerve paresis, which may occur unilaterally or bilaterally. Although less common, oculomotor and trochlear nerve palsies have been reported as well. The optic nerve complex is frequently involved in ICH and may manifest as deficits in visual acuity and field cuts. Visual deficits and ophthalmoplegia improved following appropriate management in 97% of reported cases. Conclusions Intracranial hypotension can present with a wide spectrum of visual deficits, the causes of which are multifactorial. Cranial nerve paresis, especially of the abducens nerve, is frequently reported. The majority of symptoms and cranial nerve deficits reviewed respond favorably to conservative management, epidural blood patch administration, or in a minority of cases, surgical intervention.

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Abducens nerve palsy in spontaneous intracranial hypotension

Cited by 38 publications

References 0 publications

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

Microanatomical study of the intracranial abducens nerve: clinical interest and surgical perspective

A review of ocular manifestations in intracranial hypotension

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