• Journal of Korean Neurosurgical Society
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• v.44 no.6
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• pp.396-398
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• 2008

Although the incidence of unilateral abducens nerve palsy has been reported to be as high as 1% to 2.7% of head trauma cases, bilateral abducens nerve palsy following trauma is extremely rare. In this report, we present the case of a patient who developed a bilateral abducens nerve palsy and hypoglossal nerve palsy 3 days after suffering head trauma. He had a Glasgow Coma Score (GCS) of 15 points. Computed tomography (CT) images demonstrated clivus epidural hematoma and subarachnoid hemorrhage on the basal cistern. Herein, we discuss the possible mechanisms of these nerve palsies and its management.

• Journal of Trauma and Injury
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• v.21 no.1
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• pp.66-69
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• 2008

Traumatic bilateral abducens nerve palsy is rare and is associated with intracranial, skull and cervical spine injuries. We report a case of bilateral abducens nerve palsy in a 40-month-old patient with a skull base fracture. The injury mechanism was associated with direct nerve injury caused by a right petrous bone fracture and indirect injury by frontal impact on the abducens nerve at the point of fixation to the petrous portion and Dorello's canal. The emergency physician should be aware of injuries and the mechanism of abducens nerve palsy in head trauma.

• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.112-114
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• 2013

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.

• Annals of Clinical Neurophysiology
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• v.21 no.2
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• pp.105-107
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• 2019

Acute ophthalmoparesis that includes the oculomotor, trochlear, or abducens nerve may occur as an initial presentation of Miller Fisher syndrome (MFS). The symptoms of MFS or variant forms of Guillain-Barre syndrome are pathogenically related to anti-GQ1b antibodies. We report a case of a 36-year-old man with unilateral isolated abducens nerve palsy associated with anti-GM1 antibody. To the best of our knowledge, this is the first report of unilateral isolated abducens nerve palsy with positivity for anti-GM1 immunoglobulin M antibody.

• Journal of Korean Neurosurgical Society
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• v.46 no.6
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• pp.581-583
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• 2009

Abducens nerve palsy associated with spinal surgery is extremely rare. We report an extremely rare case of abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing, which resolved spontaneously and completely. A 61-year-old previous healthy man presented with chronic lower back pain of 6 weeks duration and 2 weeks history of bilateral leg pain. He was diagnosed as having isthmic spondylolisthesis at L4-5 and L5-S1, and posterior lumbar interbody fusion was conducted on L4-5 and L5-S1. During the operation, inadvertent dural tearing occurred, which was repaired with a watertight dural closure. The patient recovered uneventfully from general anesthesia and his visual analogue pain scores decreased from 9 pre-op to 3 immediately after his operation. However, on day 2 he developed headache and nausea, which were severe when he was upright, but alleviated when supine. This led us to consider the possibility of cerebrospinal fluid leakage, and thus, he was restricted to bed. After an interval of bed rest, the severe headache disappeared, but four days after surgery he experienced diplopia during right gaze, which was caused by right-side palsy of the abducens nerve. Under conservative treatment, the diplopia gradually disappeared and was completely resolved at 5 weeks post-op.

• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.194-196
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• 2013

Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.

• The Korean Journal of Pain
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• v.25 no.2
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• pp.112-115
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• 2012

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.31 no.4
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• pp.117-125
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• 2018

Objectives : The purpose of this study is to report the effect of Korean medicine treatment on diplopia and limitation of eye movement in Idiopathic abducens nerve palsy. Methods : Two patients were treated with acupuncture and herbal medicines who has been suffering from diplopia and limitation of eye movement. To evaluate the results of this treatment, we everyday checked distance(cm) from middle of the forehead to occurring diplopia, limitation of abduction(Scott and Kraft grade) and other symptoms(visual analogue sacle). Results : After treatment, the limitation of eye movement and diplopia were improved remarkably even other symptoms. Conclusions : This study shows us that the Korean medicine treatments are effective on diplopia and limitation of eye movement due to idiopathic abducens nerve palsy.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.35 no.3
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• pp.114-122
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• 2022

Objective : The purpose of this study is to report the effect of Korean medicine treatments of abducens nerve palsy after cancer immunotherapy. Methods : A 63-year-old male patient who was suffering hepatocellular carcinoma had left eye abduction restriction, diplopia, and decreased visual acuity after taking 5^th cancer immunotherapy(atezolizumab + bevacizumab). Western medicine was administered for 3 weeks, but there was no response. The patient was treated with herbal medicine, acupuncture, electroacupuncture, moxibustion and bee venom pharmacoacupuncture for 4 weeks. Result : The patient's eye abduction restriction and diplopia were resolved. Visual acuity was improved from NRS(Numerical Rating Scale) 8 to NRS 2. The patient continued immunotherapy and there was no worsening of symptoms. No adverse events were observed. Conclusions : This study shows that Korean medicine treatments were effective on abducens nerve palsy after cancer immunotherapy.

• Annals of Clinical Neurophysiology
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• v.22 no.1
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• pp.46-47
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• 2020