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Isolated Abducens Nerve Palsy Due to Focal Patchy Inflammatory Lesion and Review of the Literature


Affiliations
1 B.J.Medical College, Pune, India
2 Ruby Hall Clinic, Pune, India
     

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Background: Convergent squint due to 'isolated abducens nerve palsy' (IANP) in otherwise normal patients is not often seen. Reports on natural history related to causes, time of improvement and recurrences is varied and perplexing. Objective 1) to relate IANP to the 'focal patchy inflammatory dural lesion' (FPIDL) along the lateral wall of cavernous sinus using magnetic resonance imaging (MRI), 2) to assess the use of anti-inflammatory drugs and steroids, 3) understanding incidence of recovery and recurrences. Patient&method: Retrospective review of seven patients of IANP with MRI neuroimaging and steroidal therapy. Cerebrospinal fluid (CSF) was investigated in four patients only. Results: MRI showed FPIDL affecting lateral wall of cavernous sinus all along the abducens nerve tract. Recurrent palsy similar independent lesion. Both treated with anti-inflammatory and steroidal drug therapy. Follow-up MRIs within two weeks of therapy shows significant recovery with regression of FPIL. Conclusion: Skull base MRI differentiates FPIDL from intra-nuclear and other structural causes. IANP recurrences appear independent, have similar lesions and also respond to anti-inflammatory and steroidal therapy. The authors suggest MRI-skull base neuroimaging and reviews IANP.

Keywords

Isolated Abducens Nerve Palsy, Focal Patchy Inflammatory Dural Lesion, Skull Base MRI.
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  • Isolated Abducens Nerve Palsy Due to Focal Patchy Inflammatory Lesion and Review of the Literature

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Authors

R. Sangle
B.J.Medical College, Pune, India
V. Nivargi
Ruby Hall Clinic, Pune, India
P. Dixit
Ruby Hall Clinic, Pune, India

Abstract


Background: Convergent squint due to 'isolated abducens nerve palsy' (IANP) in otherwise normal patients is not often seen. Reports on natural history related to causes, time of improvement and recurrences is varied and perplexing. Objective 1) to relate IANP to the 'focal patchy inflammatory dural lesion' (FPIDL) along the lateral wall of cavernous sinus using magnetic resonance imaging (MRI), 2) to assess the use of anti-inflammatory drugs and steroids, 3) understanding incidence of recovery and recurrences. Patient&method: Retrospective review of seven patients of IANP with MRI neuroimaging and steroidal therapy. Cerebrospinal fluid (CSF) was investigated in four patients only. Results: MRI showed FPIDL affecting lateral wall of cavernous sinus all along the abducens nerve tract. Recurrent palsy similar independent lesion. Both treated with anti-inflammatory and steroidal drug therapy. Follow-up MRIs within two weeks of therapy shows significant recovery with regression of FPIL. Conclusion: Skull base MRI differentiates FPIDL from intra-nuclear and other structural causes. IANP recurrences appear independent, have similar lesions and also respond to anti-inflammatory and steroidal therapy. The authors suggest MRI-skull base neuroimaging and reviews IANP.

Keywords


Isolated Abducens Nerve Palsy, Focal Patchy Inflammatory Dural Lesion, Skull Base MRI.

References