Bilateral Abducent Nerve Palsy After Neck Trauma: A Case Report

Abstract

IntroductionThe abducent nucleus is located in the upper part of the rhomboid fossa beneath the fourth ventricle in the caudal portion of the pons. The abducent nerve courses from its nucleus, to innervate the lateral rectus muscle. This nerve has the longest subarachnoid course of all the cranial nerves, it is the cranial nerve most vulnerable to trauma. It has been reported that 1% to 2.7% of all head injuries are followed by unilateral abducent palsy, but bilateral abducent nerve palsy is extremely rare.Case PresentationA 65-year-old woman presented to the emergency department following a motor vehicle accident. A neurological assessment showed the patient’s Glascow coma scale (GCS) to be 15. She complained of double vision, and we found lateral gaze palsy in both eyes. A hangman fracture type IIA (C2 fracture with posterior ligamentous C1 - C2 distraction) was found on the cervical CT scan. A three-month follow-up of the patient showed complete recovery of the abducent nerve.ConclusionsConservative treatment is usually recommended for traumatic bilateral abducent nerve palsy. Our patient recovered from this condition after three months without any remaining neurological deficit, a very rare outcome in a rare case.

Multiple Sclerosis Manifested by Paralysis of Cranial VI Pair with Diplopia

“…Although MS is an uncommon cause of cranial nerve palsies, its frequency increases in young individuals, with a predominance of abducens nerve palsy, as occurred with the patient in the present report, emphasizing the importance of knowing the profile of this disease [14][15][16][17].…”

“…Although optic neuritis was the most commonly observed alteration, the possibility that other ocular alterations precede or accompany the disease should be highlighted. course of the disease [17,19,[20][21][22]. This perception was fundamental in the patient's condition, since her clinical condition began with diplopia secondary to abducens nerve paralysis and not due to manifestations related to optic neuritis.…”

“…Eye pain was present in almost all our patients (95%) who had optic neuritis, and this manifestation was not present in our patient. Internuclear ophthalmoplegia is the most common cause of eye movement abnormalities and diplopia in MS, occurring in approximately half of the cases [15][16][17][18][19].…”

“…Most people with MS begin the clinical picture as an attack, but MS can involve any part of the CNS. Ocular findings in MS include optic neuritis, retinitis, peripheral vasculitis, ocular motility abnormalities that present with diplopia or nystagmus, and pars planitis [1,12,17,20,21]. All of them must be recognized by the ophthalmologist, although optic neuritis, due to its high frequency and established correlation with MS, is the most important ocular change in the follow-up of these patients [14,19,[20][21][22][23].…”

Effects of Intraorbital Electroacupuncture on Diabetic Abducens Nerve Palsy

“…In the previously research, the recovery rate was 57.3%[ 3 ] and was beginning from 3 months after the first onset. [ 4 ] Evidently, the whole treatment period was remarkably shorter than conventional method,[ 5 ] with a significant higher cure rate. The maximal angle of diplopia for the 53 cases is 4.55°, which was close to the normal adult references in our former study.…”