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Clinical Images  |   January 2014
Abducens Palsy
Author Notes
  • 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: skorin.leonid@mayo.edu  
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   January 2014
Abducens Palsy
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 67. doi:10.7556/jaoa.2014.015
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 67. doi:10.7556/jaoa.2014.015
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. 
   Financial Disclosures: None reported.
 
References
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. [CrossRef] [PubMed]
Goodwin D. Differential diagnosis and management of acquired sixth cranial nerve palsy. Optometry. 2006;77(11):534-539. [CrossRef] [PubMed]