Spontaneous resolution of sixth nerve palsy with ipsilateral cavernous carotid dolichoectasia

Severe unilateral abducens nerve palsy from cavernous sinus carotid vascular ectasia

Purpose

Carotid cavernous sinus ectasia is a rare cause of abducens nerve palsy.

Observation

We present a case of severe unilateral progressive esotropia resulting from cavernous sinus carotid vascular ectasia in a 67 y/o female. She had progressive esotropia over the years with no neuroimaging despite having regular ophthalmic care. Magnetic resonance imaging determined the etiology of her chronic severe esotropia.

Conclusion and importance

Carotid cavernous sinus ectasia should be considered in the differential of severe progressive unilateral abducens nerve palsy. Magnetic resonance imaging with magnetic resonance angiography is important to determine etiology of severe progressive esotropia.

Ophthalmic segment aneurysmal subarachnoid hemorrhage presenting with contralateral abducens nerve palsy: a false localizing sign

BACKGROUND

Neuro-ophthalmic manifestations of aneurysmal subarachnoid hemorrhage are commonly linked to a palsy of the cranial nerve in close proximity to the aneurysm or to chronic intracranial hypertension.

CASE REPORT

A patient with subarachnoid hemorrhage secondary to a rupture of an intracranial right ophthalmic segment internal carotid artery aneurysm presented with an acute-onset contralateral abducens nerve palsy. There were no clinical or radiologic features of chronic intracranial hypertension. Magnetic resonance imaging showed a co-existent ectatic basilar artery on the left side of the pons in close relation to the sixth nerve.

CONCLUSION

Abducens weakness in the above-50 age group is most commonly caused by a vascular etiology. The authors discuss the pathogenesis of this rare clinical entity and present pertinent literature review.