Temporal Arteritis Presenting as an Isolated Bilateral Abducens Nerve Palsy: A Rare Case of a 65-year-old Male

Lunagariya, Abhishek; Rupareliya, Chintan; Bollu, Pradeep C.; Mahuwala, Zabeen

doi:10.7759/cureus.2667

Cited by 6 publications

(11 citation statements)

References 18 publications

(21 reference statements)

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“…Isolated abducens palsy may be congenital, traumatic, post-viral, microvascular, or idiopathic [4,[7][8][9]. Bilateral abducens palsy has diverse etiologies like increased ICP, Wernicke-Korsakoff syndrome, Guillain-Barre syndrome, giant cell arteritis, and post-operative or iatrogenic [2,10]. There are reports of multiple sclerosis presenting as isolated abducens nerve palsy [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Patients presenting with bilateral sixth nerve palsy need evaluation for raised intracranial tension, mass lesions, trauma, demyelinating diseases, and underlying vasculitis. There are reports describing isolated bilateral sixth nerve palsy in cases of trauma, aneurysmal rupture, and temporal arteritis [2][3][4]. However, a recurrent stroke with bilateral pontine infarct presenting as isolated bilateral sixth nerve palsy is rare.…”

Section: Introductionmentioning

confidence: 99%

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

Kumar¹,

Seju²,

Meena³

et al. 2022

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kumar¹,

Seju²,

Meena³

et al. 2022

Cureus

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“…Most case reports in recent years associate GCA with varying visual changes [ 3 - 5 ] or overlapping conditions [ 10 - 11 ]. The only other case report with similar findings is from 2002, but that patient also had chewing-induced jaw pain [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Typically, patients initially present with new-onset headaches, visual changes and disturbances, jaw claudication, arthralgias, and tender or swollen temporal or occipital arteries. Other symptoms include low-grade fever, malaise, and scalp pain [1][2][3][4][5][6][7]. We describe a patient that presented with only bilateral headache and fevers but ultimately was diagnosed with bilateral GCA.…”

Section: Introductionmentioning

confidence: 99%

An Unusual Case of Giant Cell Arteritis

Goyal¹,

Basnet²,

Donenfeld³

et al. 2022

Cureus

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Giant cell arteritis (GCA), also known as temporal arteritis (TA), is a systemic autoimmune inflammation of medium and large arteries. It is the most common vasculitis affecting adults older than 50, with an incidence of 20/100,000 and an average age of onset of 70. Typically, patients initially present with new-onset headaches, visual changes and disturbances, jaw claudication, arthralgias, and tender or swollen temporal or occipital arteries. Our patient is a 73-year-old male who presented to the emergency room with 10 days of bilateral headache radiating to the occipital area associated with fevers, persistent chills, generalized weakness, and a headache described as constant, dull, 9 out of 10 pain, and minor pain with neck flexion. Lab work revealed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The patient had tender palpation to his temples and due to a high suspicion of giant cell arteritis, he was started on high-dose steroids with rapid relief of his symptoms. Biopsy showed evidence of active nongranulomatous vasculitis and confirmed bilateral temporal arteritis within the context of the clinical setting. GCA patients are more likely to be women and typically present with unilateral headache (66% of GCA), jaw claudication (50%), fevers (50%), and transient visual loss (16-54%). Here, we describe a 73-year-old male with a past medical history of cerebral vascular accident (CVA), diabetes, and cancer that presented with 10 days of bilateral headaches and fevers. Unlike the usual presentation, our patient denied any vision and joint pain changes, and the temporal arteries were not stiff to palpation. This patient presentation is unique to previous reports in the limited display of symptoms and absence of the most commonly associated manifestations. Although his presentation supported GCA, the features of elevated ESR and CRP, headache, and fever were too general to diagnose GCA exclusively, and his additional symptoms of rhinorrhea and sinus pain more likely supported infection. Our case indicates the importance of maintaining a high index of clinical suspicion for GCA in the elderly population presenting with headaches and elevated ESR and CRP. GCA, also known as temporal arteritis (TA), is a systemic autoimmune inflammation of medium and large arteries. Typically, patients initially present with new-onset headaches, visual changes and disturbances, jaw claudication, arthralgias, and tender or swollen temporal or occipital arteries. Diagnosis requires high clinical suspicion, and treatment revolves around high doses of steroids.

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“…[2] Ophthalmic manifestations of GCA vary from retinal infarction, ischemia to optic nerve, cortical blindness, pupillary autonomic dysfunction and cranial nerves (CNs) palsies. [3] GCA is a medical emergency and, once suspected, it warrants immediate diagnosis and management to prevent irreversible damage. [1] We report a suspected case of GCA in a patient presenting with headache, visual loss, diplopia and unilateral sixth nerve palsy.…”

Section: Introductionmentioning

confidence: 99%

Giant Cell Arteritis: A Case Report

Soliman

2022

GJMCR

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Giant cell arteritis (GCA) with ocular involvement is an emergency condition, and treatment with glucocorticoids should be provided immediately upon clinical suspicion of GCA to prevent potential blindness. In this case report, we discuss a case of a 70-years-old Caucasian male presented to the emergency department with one day sudden onset of double vision. This is a teaching case report aimed to discuss the management options, potential complications and visual prognosis of this particular case.

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Temporal Arteritis Presenting as an Isolated Bilateral Abducens Nerve Palsy: A Rare Case of a 65-year-old Male

Cited by 6 publications

References 18 publications

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

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

An Unusual Case of Giant Cell Arteritis

Giant Cell Arteritis: A Case Report

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