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Abducens Palsy

  • Leonid Skorin and Jacob Bollman
Published/Copyright: January 1, 2014
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 114 Issue 1

A 53-year-old woman presented with bin-ocular horizontal diplopia, which started 8 months prior. She had been unsuccessfully treated with prismatic correction and reported no recent trauma to her eyes or head, which is the most common acquired cause of abducens palsy.1 Ocular examination findings revealed a unilateral decrease in her visual acuity of 20/30-1 OD and 20/20-1 OS and reduced color perception OD. The patient's pupils were equal, round, and reactive to light without an afferent pupillary defect. Extra-ocular muscle testing revealed limited abduction OD (image A), indicative of right abducens palsy. Forced duction test results were negative for restrictions, indicating a neurogenic origin.2 Glucose levels, thyroid-stimulating hormone levels, and sedimentation rate were normal, and laboratory results were negative for Lyme disease.

A magnetic resonance image of the brain and orbit revealed an aneurysm (2.8 cm anterior-posterior by 2.8 cm craniocaudal) of the right internal carotid artery in the cavernous sinus (image B, arrow). Cerebral angiography depicted aneurysm thrombosis of 60% with compression and partial stenosis of the right internal carotid artery. The patient was given 325 mg aspirin and 75 mg clopidogrel daily and 1 month later underwent an uncomplicated Pipeline embolization of the aneurysm. The patient did not experience immediate resolution of abducens palsy after surgical correction. At 6 months, her ocular deviation did not change, and she now wears an eye patch to relieve the diplopia.

From Mayo Clinic Health System in Albert Lea, Minnesota (Dr Skorin), and Granite Family Eye Care in Granite Falls, Minnesota (Dr Bollman). Dr Bollman was a student at the Pacific University College of Optometry in Forest Grove, Oregon, at the time of this case
Address correspondence to Leonid Skorin Jr, DO, OD, MS, Mayo Clinic Health System, 404 W Fountain St, Albert Lea, MN 56007-2437. E-mail:

  1. Financial Disclosures: None reported.

References

1 Hsu CS Closmann JJ Baus MR . Idiopathic unilateral cranial nerve VI palsy: a case report and review of the literature. J Oral Maxillofac Surg.2008;66(6):1282-1286. doi:10.1016/j.joms.2007.04.035.10.1016/j.joms.2007.04.035Search in Google Scholar PubMed

2 Goodwin D . Differential diagnosis and management of acquired sixth cranial nerve palsy. Optometry. 2006;77(11):534-539.10.1016/j.optm.2006.08.014Search in Google Scholar PubMed

Received: 2013-05-08
Revised: 2013-06-26
Accepted: 2013-07-10
Published Online: 2014-01-01
Published in Print: 2014-01-01

© 2014 The American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2014.015
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. Abstracts
  2. 2013 SOMA Abstracts and Poster Competition
  3. 2013 BIOM Abstracts and Poster Competition
  4. Editorial
  5. Our Past, Present, and Future Are in Our Hands
  6. Letters
  7. Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion
  8. Original Contribution
  9. The Persistence of Lumbar Somatic Dysfunction and Its Association With Bone Mineral Density
  10. Medical Education
  11. Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
  12. Special Communication
  13. A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
  14. A Research Primer, Part 2: Guidelines for Developing a Research Project
  15. Case Report
  16. A Case of Seasonal Recurrent Myopericarditis
  17. A Case of Idiopathic Colonic Varices
  18. The Somatic Connection
  19. OMT Relieves Severe Chronic Low Back Pain
  20. Abdominal Muscles Are the Front Side of the Low Back
  21. Systematic Review Paints Incomplete Picture of OMT Research
  22. Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis
  23. Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
  24. A Chiropractic Perspective: Spinal Manipulative Therapy Is Not Causally Related to Stroke
  25. Clinical Images
  26. Abducens Palsy
  27. In Your Words
  28. No Place Like HOME
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