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Abducens Nerve Palsy Workup

  • Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, FRCSC  more...
 
Updated: May 17, 2016
 

Laboratory Studies

See the list below:

  • Complete blood cell (CBC) count
  • Diabetes testing (glucose, glycosylated hemoglobin [HbA1C], glucose tolerance test)
  • Erythrocyte sedimentation rate and/or C-reactive protein
  • Acetylcholine receptor antibodies in the presence of variable strabismus or ptosis

The following are not mainstream tests for abducens palsy but can be considered:

  • Rapid plasma reagin test
  • Fluorescent treponemal antibody-absorption test
  • Lyme titer
  • Antinuclear antibody test
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Imaging Studies

MRI is indicated for the following:

  • Patients younger than 55 years with no vasculopathic history
  • Associated pain or other neurologic abnormality [11]
  • History of cancer
  • Bilateral sixth nerve palsy
  • Papilledema
  • In the event no marked improvement is seen or other nerves become involved

An LP should be considered if MRI results are negative.

If a presumed microvascular ischemic sixth nerve palsy does not improve within 3-4 months or if other cranial nerves become involved, a full medical, neurologic, and imaging workup should be performed.

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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, 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, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

Acknowledgments

The authors and editors of Medscape Reference 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. Neuro-ophthalmology Review Manual. 6th ed. SLACK Inc; 2008.

  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. 2008 Oct. 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. 2008 Feb. 12(1):91-3. [Medline].

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

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

  8. Kurbanyan K, Lessell S. Intracranial hypotension and abducens palsy following upper spinal manipulation. Br J Ophthalmol. 2008 Jan. 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. 2008 Dec 16. [Medline].

  10. Anwar S, Nalla S, Fernando DJ. Abducens nerve palsy as a complication of lumbar puncture. Eur J Intern Med. 2008 Dec. 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. 2011 Dec. 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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