Differential diagnosis and management of acquired sixth cranial nerve palsy

Goodwin, Denise

doi:10.1016/j.optm.2006.08.014

Cited by 27 publications

(25 citation statements)

References 14 publications

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“…This leads to our speculation that some patients presenting clinically with abducens palsy may in fact have inflammation of the lateral rectus muscle, which may be overlooked unless specifically assessed. Although cerebral MR imaging or CT is mandatory in the diagnostic work-up of abducens palsy in younger patients, 4 our case illustrates that thickening of the lateral rectus muscle may be missed when the focus is centered on other structures. Orbital myositis should be considered in the differential diagnosis of abducens palsy, especially in younger individuals.…”

Section: Discussionmentioning

confidence: 82%

“…3 In younger patients, nerve compression by aneurysms or tumors, multiple sclerosis, and vascular brain stem lesions must be considered, yet in many cases, the cause remains elusive. 4,5 Typically, orbital myositis can be differentiated from neurogenic lesions because of the characteristic clinical triad of periorbital pain, diplopia, and signs of inflammation, such as conjunctival injections or swelling. Concurrent pain is present in Ͼ95% of all cases.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Orbital Myositis Mimicking Sixth Nerve Palsy: Diagnosis with MR Imaging

Fischer¹,

Kempkes²,

Haage³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY:We present a case with recurrent orbital myositis sequentially affecting both lateral rectus muscles separately. In the first episode, the absence of the required symptoms for the diagnosis of orbital myositis led to the erroneous diagnosis of sixth nerve palsy. Eventually, the correct diagnosis was established with cerebral MR imaging. Orbital myositis should be included in the differential diagnosis of what appears clinically to be abducens palsy, and MR imaging with a focus on the orbita is mandatory in such patients.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Recurrent Orbital Myositis Mimicking Sixth Nerve Palsy: Diagnosis with MR Imaging

Fischer¹,

Kempkes²,

Haage³

et al. 2009

AJNR Am J Neuroradiol

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“…5,6 In case of a sixth nerve palsy, abduction (outward movement of the eye) is restricted, while a third nerve palsy may cause restrictions in any combination of adduction, elevation, and depression because it is the innervation to the extra-ocular muscles that is involved in these gaze positions. 15 A sixth nerve palsy of vascular or unknown origin typically resolves within six to eight weeks. 15 The fourth cranial nerve innervates the superior oblique muscle which is responsible for intorsion and some vertical movement.…”

Section: Binocular Vision Disordermentioning

confidence: 99%

“…15 A sixth nerve palsy of vascular or unknown origin typically resolves within six to eight weeks. 15 The fourth cranial nerve innervates the superior oblique muscle which is responsible for intorsion and some vertical movement. A fourth nerve palsy usually presents with complaints of a vertical diplopia, especially when looking away from the lesion.…”

Section: Binocular Vision Disordermentioning

confidence: 99%

Diplopia

Mashige

Munsamy

2015

South African Family Practice

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“…Six weeks later, ocular motility was normal, and an MRI of the left forearm showed reduction of muscle edema. The sixth cranial nerve (abducens nerve) innervates the lateral rectus muscle, which is responsible for abducting the eye [1]. Abducens nerve palsies occur more frequently in children while they are unusual in young adults [2,3].…”

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confidence: 99%

Abducens nerve palsy during sepsis

et al. 2015

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A 28-year-old man presented with fever, myalgia and swelling of the left forearm. The history was remarkable for cystic fibrosis, pulmonary and renal transplants complicated by rejection, compensated diabetes mellitus, and hemodialysis fistula on the left forearm. Two days later, the fever disappeared, but the patient complained of sudden onset diplopia and left ocular pain. Neurologic examination revealed a left abduction deficit, consistent with left abducens nerve palsy (Fig. 1a).Pharmacologic history included mycophenolate mofetil, tacrolimus, prednisone, antihypertensive drugs, and insulin. Blood studies showed high CRP (9.38 mg/dl; n.v. \0.5) and procalcitonin (95.56 ng/ml; n.v. 0.002-0.06). Blood cultures were negative. Treatment with daptomycin 6 mg/ kg/day every other day and meropenem 1 g/day was started. Viral and antibody testing were negative. A brain MRI without contrast was normal. T2-weighted MRI of the left forearm revealed hyperintensity of the muscular and subcutaneous tissues, consistent with inflammatory edema (Fig. 1b). Two weeks later, blood studies showed normal CRP (0.42 mg/dl; n.v.\0.5) and near normal procalcitonin (2.57 ng/ml; n.v. 0.02-0.06). Six weeks later, ocular motility was normal, and an MRI of the left forearm showed reduction of muscle edema. The sixth cranial nerve (abducens nerve) innervates the lateral rectus muscle, which is responsible for abducting the eye [1]. Abducens nerve palsies occur more frequently in children while they are unusual in young adults [2,3]. The leading causes of acquired abducens nerve palsy are neoplasm and trauma [2,4]. Inflammatory palsies are less frequent and can recover after appropriate treatment, as was the case in our patient [2].

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Differential diagnosis and management of acquired sixth cranial nerve palsy

Cited by 27 publications

References 14 publications

Recurrent Orbital Myositis Mimicking Sixth Nerve Palsy: Diagnosis with MR Imaging

Recurrent Orbital Myositis Mimicking Sixth Nerve Palsy: Diagnosis with MR Imaging

Diplopia

Abducens nerve palsy during sepsis

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