Abducens Nerve Palsy Caused by the Ophthalmic Segment of an Internal Carotid Artery Aneurysm. |
Inhye Kim, Jong Hoon Kim, Won Jae Kim |
1Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. eyekwj@ynu.ac.kr 2Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea. |
눈분절 속목동맥자루에 의한 가돌림신경마비 1예 |
김인혜1⋅김종훈2⋅김원제1 |
영남대학교 의과대학 안과학교실1, 영남대학교 의과대학 신경외과학교실2 |
Correspondence:
Won Jae Kim, Email: eyekwj@ynu.ac.kr |
Received: 9 November 2017 • Revised: 5 December 2017 • Accepted: 22 March 2018 |
Abstract |
PURPOSE To report a case of isolated abducens nerve palsy caused by the ophthalmic segment of an internal carotid artery (ICA) aneurysm which improved after endovascular coil trapping. CASE SUMMARY: A 59-year-old female visited the ophthalmology department for a sudden onset of horizontal diplopia for 10 days. The best corrected visual acuity was 20/20 in both eyes. The pupils showed normal response to light and near stimulation in both eyes. The extraocular examination showed 35 prism diopters left esotropia at primary gaze and −4 abduction limitation of the left eye. The patient suffered intermittent headaches in the left temporal area and left retrobulbar pain for 1 month. Magnetic resonance imaging with magnetic resonance angiography of the brain was performed. A focal protruding lesion of the left ICA suggested an aneurysm. The patient consulted with the neurosurgery department. The left ophthalmic segment of the ICA aneurysm was confirmed by transfemoral cerebral angiography and treated with coil placement and the patient showed gradual improvement after the procedure. Three months after the procedure there was no diplopia. The patient showed orthotropia at primary gaze without abduction limitation. CONCLUSIONS: Isolated abducens nerve palsy can be caused by the ophthalmic segment of an ICA aneurysm, which should be considered in the differential diagnosis of ocular motility disorders. The disorder improved with coil replacement treatment. Differential diagnosis as a cause of abducens nerve palsy is important for prompt and appropriate treatment. Neuroimaging should be considered in patients with isolated abducens nerve palsy with a non-ischemic origin. |
Key Words:
Abducens nerve palsy;Aneurysm;Diplopia;Internal carotid artery |