Isolated Bilateral Abducens Palsy as a Presenting Feature of Multi-Infarct State: A Case Report

Abstract

Isolated abducens palsy is a rare clinical entity. The usual causes of bilateral sixth nerve palsy are head trauma, tumor (skull base), aneurysm, and ischemic stroke. Bilateral abducens palsy without any other neurological deficit secondary to ischemic stroke is a rare clinical presentation. We present a case of a 78year-old male without any comorbidities with a history of diplopia for the last two months. Physical examination was unremarkable except for bilateral sixth nerve palsy. MRI brain showed the chronic ischemic area in the pons, bilateral basal ganglia, deep white matter, and periventricular region of bilateral frontal, temporal, parietal, and occipital lobe. This report highlights an unusual presentation of ischemic stroke as isolated bilateral abducens palsy without any other focal neurological deficit.

More Than Meets the Eye: Isolated Bilateral Abducens Nerve Palsy as the Initial Presentation of Multiple Sclerosis

“…Among older patients, small-vessel vascular disease, giant cell arteritis, and diabetic neuropathy should be considered as well. Other possible etiologies include cavernous sinus thrombosis, Wernicke-Korsakoff syndrome, and Guillain-Barre syndrome [ 7 , 11 - 13 ].…”