Abducens nerve palsy

Case contributed by Dr Michał Czerny

Presentation

Female patient admitted to hospital with diplopia. MRI was obtained with a suspicion of sixth nerve palsy.

Patient Data

Age: 55
Gender: Female
MRI

There is a left-sided moderate compression of the sixth nerve at the root entry zone caused by a tortuous course of vertebral arteries fusion into basilar artery. Based on the imaging as the most probable cause of patient's symptoms, neurovascular conflict of the abducens nerve should be considered. 

Annotated image

Key image with arrow pointing to the spot of nerve root entry zone moderately compressed by vascular loop (vertebral artery transition into basilar artery).

Case Discussion

This case presents an interesting and rare probable cause of sixth nerve palsy. When the MRI was performed there were no other presumptions explaining symptoms.  Unfortunately, the patient has been lost to radiology follow-up and there is no feedback about any later clinical indications for other causes of palsy. Neurosurgical consult was suggested because of striking MRI appearance.

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Case information

rID: 57084
Case created: 6th Dec 2017
Last edited: 16th Dec 2017
Inclusion in quiz mode: Excluded

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