Abducens Nerve Palsy Workup

  • Author: Michael P Ehrenhaus, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

Laboratory Studies

  • Complete blood cell (CBC) count
  • Glucose levels
  • Glycosylated hemoglobin (HbA1C)
  • Erythrocyte sedimentation rate and/or C-reactive protein
  • Rapid plasma reagin test
  • Fluorescent treponemal antibody-absorption test
  • Lyme titer
  • Glucose tolerance test
  • Antinuclear antibody test
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Imaging Studies

  • Skull series
    • Stereoscopic submental-vertex basal view of the skull (to inspect the basal foramina)
    • If no marked improvement after 6 weeks or if other cranial nerves become involved, then a more thorough evaluation is indicated, such as a full medical and neurologic workup, CT scan with and without contrast, MRI, LP, and cerebral angiography.
  • MRI is indicated for the following:
    • Patients younger than 45 years
    • Associated pain or other neurologic abnormality[11]
    • History of cancer
    • Bilateral sixth nerve palsy
    • Papilledema
    • Patients younger than 55 years with no vasculopathic history
    • In the event no marked improvement is seen or other nerves become involved
  • An LP should be considered if MRI results are negative.
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Other Tests

  • Check history for diabetes mellitus, cancer, thyroid disease, and hypertension.
  • Ask about history of recent trauma, ear infections (children), and fluctuation of symptoms.
  • An otoscopic examination may be performed in children to rule out a complicated otitis media (consider an LP).
  • Rule out other cranial nerve involvement.
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Procedures

  • A temporal artery biopsy may be indicated if findings and laboratory studies suggest giant cell arteritis.
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Contributor Information and Disclosures
Author

Michael P Ehrenhaus, MD  Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center

Michael P Ehrenhaus, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Coauthor(s)

Mohammedyusuf E Hajee, MD  Clinical Instructor, Staff Physician, Department of Ophthalmology, Director, Blood Flow Laboratory, State University of New York-Downstate Medical Center

Mohammedyusuf E Hajee, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, and National Medical Association

Disclosure: Nothing to disclose.

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew W Lawton, MD  Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

References

  1. Evans NM. Ophthalmology. 2nd ed. Oxford University Press Inc; 1995.

  2. Kline LB, Bajandas FJ. Neuro-ophthalmology Review Manual. 3rd ed. University of Alabama, Birmingham; 1988.

  3. Yanoff M, Duker JS. Ophthalmology. Mosby International Ltd; 1999.

  4. Ayberk G, Ozveren MF, Yildirim T, et al. Review of a series with abducens nerve palsy. Turk Neurosurg. Oct 2008;18(4):366-73. [Medline].

  5. Denis D, Dauletbekov D, Girard N. Duane retraction syndrome: Type II with severe abducens nerve hypoplasia on magnetic resonance imaging. J AAPOS. Feb 2008;12(1):91-3. [Medline].

  6. Calisaneller T, Ozdemir O, Altinors N. Posttraumatic acute bilateral abducens nerve palsy in a child. Childs Nerv Syst. Jul 2006;22(7):726-8. [Medline].

  7. Dwarakanath S, Gopal S, Venkataramana NK. Post-traumatic bilateral abducens nerve palsy. Neurol India. Jun 2006;54(2):221-2. [Medline].

  8. Kurbanyan K, Lessell S. Intracranial hypotension and abducens palsy following upper spinal manipulation. Br J Ophthalmol. Jan 2008;92(1):153-5. [Medline].

  9. Hanu-Cernat LM, Hall T. Late onset of abducens palsy after Le Fort I maxillary osteotomy. Br J Oral Maxillofac Surg. Dec 16 2008;[Medline].

  10. Anwar S, Nalla S, Fernando DJ. Abducens nerve palsy as a complication of lumbar puncture. Eur J Intern Med. Dec 2008;19(8):636-7. [Medline].

  11. Tsai TH, Demer JL. Nonaneurysmal cranial nerve compression as cause of neuropathic strabismus: evidence from high-resolution magnetic resonance imaging. Am J Ophthalmol. Dec 2011;152(6):1067-1073.e2. [Medline]. [Full Text].

  12. Rhee DJ, Pyfer MF. The Wills Eye Manual: Office and Emergency Room diagnosis and treatment of eye disease. Lippincott Williams & Wilkins; 1999.

 
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