Benign Recurrent Sixth (Abducens) Nerve Palsy following Measles-Mumps-Rubella Vaccination

Abstract

Benign, isolated, recurrent sixth nerve palsy is rare in children. It may be associated with febrile viral illness and vaccination in exceptional circumstances although this is a diagnosis of exclusion. Here, we present the case of a 2-year-old Caucasian girl who developed recurrent 6th nerve palsy following vaccination with the measles-mumps-rubella (MMR) vaccine. No underlying pathology was identified following extensive investigations and followup. There is limited data available on the pathophysiology of vaccination-related nerve palsies. As with all previous reports of cranial nerve palsies following vaccination, there was complete resolution in this case. Long term followup with repeated physical examination and investigations is warranted to avoid missing severe pathology and operating unnecessarily.

Sixth Nerve Palsy in Children Etiology, Long-Term Course, and a Diagnostic Algorithm

“…16 Similar to our patient, Bourtoulamaiou et al reported a 2-year-old patient with sixth nerve palsy one week following MMR vaccine. 17 The palsy resolved spontaneously but recurred twice thereafter, independent of the vaccination. Anti-GQ1B was not tested in this patient.…”

Sixth Nerve Palsy in Children Etiology, Long-Term Course, and a Diagnostic Algorithm

“…16 Similar to our patient, Bourtoulamaiou et al reported a 2-year-old patient with sixth nerve palsy one week following MMR vaccine. 17 The palsy resolved spontaneously but recurred twice thereafter, independent of the vaccination. Anti-GQ1B was not tested in this patient.…”

Acute abducens nerve palsy following COVID-19 vaccination

“…Abducens nerve palsies have also been reported in measles-mumps-rubella, hepatitis B, and annual influenza vaccines, with onset ranging from 2 days to 3 weeks from time of vaccination. [6][7][8] Postimmunization abducens nerve palsies typically resolve spontaneously within 6 months, but they can be recurrent. [5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis.…”

“…[6][7][8] Postimmunization abducens nerve palsies typically resolve spontaneously within 6 months, but they can be recurrent. [5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis. [4][5][6][7][8] Isolated case reports of abducens nerve palsies have been described in setting of COVID-19 infection.…”

“…[5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis. [4][5][6][7][8] Isolated case reports of abducens nerve palsies have been described in setting of COVID-19 infection. Falcone and colleagues 9 reported an acute abducens nerve palsy in a healthy 32year-old man 3 days after developing respiratory symptoms and subsequently testing positive for COVID-19.…”

Ocular motility disorders following coronavirus disease-19 vaccination

“…Ocular motor nerve palsies following various vaccinations have been reported, with onset ranging from two days to three weeks after vaccination [ 52 – 56 ], although their occurrence is very rare. The pathophysiology behind postimmunization ocular nerve palsies remains unknown.…”

Sixth Nerve Palsy in Children Etiology, Long-Term Course, and a Diagnostic Algorithm

“…16 Similar to our patient, Bourtoulamaiou et al reported a 2-year-old patient with sixth nerve palsy one week following MMR vaccine. 17 The palsy resolved spontaneously but recurred twice thereafter, independent of the vaccination. Anti-GQ1B was not tested in this patient.…”

Acute abducens nerve palsy following COVID-19 vaccination

“…Abducens nerve palsies have also been reported in measles-mumps-rubella, hepatitis B, and annual influenza vaccines, with onset ranging from 2 days to 3 weeks from time of vaccination. [6][7][8] Postimmunization abducens nerve palsies typically resolve spontaneously within 6 months, but they can be recurrent. [5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis.…”

“…[6][7][8] Postimmunization abducens nerve palsies typically resolve spontaneously within 6 months, but they can be recurrent. [5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis. [4][5][6][7][8] Isolated case reports of abducens nerve palsies have been described in setting of COVID-19 infection.…”

“…[5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis. [4][5][6][7][8] Isolated case reports of abducens nerve palsies have been described in setting of COVID-19 infection. Falcone and colleagues 9 reported an acute abducens nerve palsy in a healthy 32year-old man 3 days after developing respiratory symptoms and subsequently testing positive for COVID-19.…”

Ocular motility disorders following coronavirus disease-19 vaccination

“…Ocular motor nerve palsies following various vaccinations have been reported, with onset ranging from two days to three weeks after vaccination [ 52 – 56 ], although their occurrence is very rare. The pathophysiology behind postimmunization ocular nerve palsies remains unknown.…”

Sixth Nerve Palsy in Children Etiology, Long-Term Course, and a Diagnostic Algorithm

“…16 Similar to our patient, Bourtoulamaiou et al reported a 2-year-old patient with sixth nerve palsy one week following MMR vaccine. 17 The palsy resolved spontaneously but recurred twice thereafter, independent of the vaccination. Anti-GQ1B was not tested in this patient.…”

Acute abducens nerve palsy following COVID-19 vaccination

“…Abducens nerve palsies have also been reported in measles-mumps-rubella, hepatitis B, and annual influenza vaccines, with onset ranging from 2 days to 3 weeks from time of vaccination. [6][7][8] Postimmunization abducens nerve palsies typically resolve spontaneously within 6 months, but they can be recurrent. [5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis.…”

“…[6][7][8] Postimmunization abducens nerve palsies typically resolve spontaneously within 6 months, but they can be recurrent. [5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis. [4][5][6][7][8] Isolated case reports of abducens nerve palsies have been described in setting of COVID-19 infection.…”

“…[5][6][7] Although the pathophysiology behind postimmunization ocular nerve palsies remains unknown, it is hypothesized to be related to immune-mediated damage resulting in demyelination or localized vasculitis. [4][5][6][7][8] Isolated case reports of abducens nerve palsies have been described in setting of COVID-19 infection. Falcone and colleagues 9 reported an acute abducens nerve palsy in a healthy 32year-old man 3 days after developing respiratory symptoms and subsequently testing positive for COVID-19.…”

Ocular motility disorders following coronavirus disease-19 vaccination

“…Ocular motor nerve palsies following various vaccinations have been reported, with onset ranging from two days to three weeks after vaccination [ 52 – 56 ], although their occurrence is very rare. The pathophysiology behind postimmunization ocular nerve palsies remains unknown.…”