J Korean Ophthalmol Soc.  2017 Sep;58(9):1110-1114. 10.3341/jkos.2017.58.9.1110.

A Case of Idiopathic Unilateral Abducens Nerve Palsy in an Adolescent Patient

• Oh SY

• KMID: 2390077
• DOI: http://doi.org/10.3341/jkos.2017.58.9.1110

Abstract

PURPOSE
To report a case of idiopathic unilateral abducens nerve palsy in an adolescent patient.
CASE SUMMARY
A healthy 14-year-old boy presented with binocular horizontal diplopia that started that same day. He did not have any history of trauma, vaccination or infectious disease and showed no other neurological signs. The best corrected visual acuity of both eyes was 20/20. Slit lamp and fundus examinations revealed no other abnormalities. On the alternative prism cover test, he had 6 prism diopter (PD) esotropia with −1 degree abduction limitation in the left eye. After 1 week, the abduction limitation in the left eye was progressed to −3.5 degrees, so we performed brain imaging. The brain magnetic resonance imaging (MRI) and systemic evaluation (serologic test, cerebrospinal fluid examination) were normal therefore, we suspected idiopathic unilateral abducens nerve palsy. Thus, intravenous steroid injection was started, and the patient was partially recovered after 5 days of treatment. At 5 weeks after presentation, diplopia and abduction limitation in the left eye were completely resolved, and recurrence was not found during the 1 year of follow-up.
CONCLUSIONS
We report a case of progressive idiopathic unilateral abducens nerve palsy in an adolescent which has resolved completely after intravenous steroid treatment in a short period.

Keyword

Abducens nerve palsy; Adolescent; Diplopia; Idiopathic

MeSH Terms

Abducens Nerve Diseases*
Abducens Nerve*
Adolescent*
Brain
Cerebrospinal Fluid
Communicable Diseases
Diplopia
Esotropia
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Neuroimaging
Recurrence
Slit Lamp
Telescopes
Vaccination
Visual Acuity

Figure

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  Figure 1 Gaze photographs 1 week after the initial presentation. After 1 week, there was esodeviation with abduction limitation in the left eye.

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  Figure 2 Gaze photographs 4 weeks after the initial presentation. After 4 weeks, there was 4 PD esodeviation of the left eye at left gaze position.

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