Recurrent isolated sixth nerve palsy secondary to an intracavernous carotid artery aneurysm

Abstract

Sir, Recurrent isolated sixth nerve palsy secondary to an intracavernous carotid artery aneurysmWe report the first case of a recurrent isolated painless sixth nerve palsy in a 60-year-old lady secondary to a large saccular aneurysm of the intracavernous carotid vasculature. This case demonstrates that recovery of an isolated sixth nerve palsy in a patient with presumed vasculopathic risk factors does not exclude a compressive lesion and may necessitate further investigation.

Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature

“…Furthermore, neuroimaging is required especially when the isolated sixth nerve palsy is chronic and recurrent. In adults >50 years of age, the differential diagnosis of an isolated chronic recurrent sixth nerve palsy most commonly includes the following: 1) vasculopathy,4 2) dolichoectasia/aneurysm,5,6 3) recurrent painful ophthalmoplegic neuropathy (previously termed ophthalmoplegic migraine),7 4) sphenoiditis,8 5) familial recurrent sixth nerve palsy,9 and 6) tumor 10,11. In the current retrospective case series over a 10-year period, we present further evidence that non-microvascular causes, such as neoplasms and aneurysms, may be more common in the isolated chronic recurrent ipsilateral sixth nerve palsies in patients >50 years of age.…”

One-Sided Headache Is a Symptom Suggesting Aneurysmal Lesion in Patients with Isolated Abducens Nerve Palsy

“…11 However, an aneurysm is a rare cause of abducens nerve palsy, with incidences of 3-4%, 12,13 and reports of cases with isolated unilateral abducens nerve palsy due to an aneurysm are still scarcer. 4,5 Our case had had recurrent diplopia episodes before her initial visit to our hospital. This history is strongly suggestive of an aneurysmal condition.…”

“…This history is strongly suggestive of an aneurysmal condition. 4,14 However, this cyclic pattern of improvement and deterioration may be confusing with spontaneous recovery at some time points.…”

“…1 In addition, reports on cases with isolated abducens nerve palsy caused by aneurismal compression are rare. 4,5 Performing neuroimaging because of the presence of headaches alone yields negative findings in most cases. 6 We report our findings of an elderly individual with an isolated unilateral abducens nerve palsy caused by a compression by a giant aneurysm.…”

Giant intracavernous carotid aneurysm presenting as isolated sixth nerve palsy in an infant

“…Cranial nerve palsies are believed to result from direct compression or acute ischemia secondary to occlusion of the vasa nervora that supply the cranial nerves. Spontaneous improvement and complete resolution are often noted, even in the setting of stabilisation or progression of the aneurysm 8 9. Mortality from ICCAA is low and spontaneous rupture is rare 10.…”