Frequently, noncontiguous cranial nerve nuclei will be affected during the course of the illness; for instance, patient 6 had left trigeminal sensory involvement, right abducens
palsy and lower motor neuron facial weakness, as well as a left palatal palsy (cranial nerve X), indicating multifocal brainstem involvement.
Wernicke's encephalopathy is characterized by nystagmus, abducens
and conjugate gaze palsy, gait ataxia and mental confusion.
Pupil-sparing oculomotor nerve palsy was seen in the right eye, but the trochlear nerve (cranial nerve IV) and the abducens
nerve (cranial nerve VI) were both intact (figure 1).
Figure 2: 12 cranial nerves Above the midbrain I Olfactory Nose Smell II Optic Eye Eye sight in four quadrants and centrally Above the pons III Oculomotor Eye Eye movement in six directions IV Trochlear Eye VI Abducens
Eye Mid pons V Trigeminal Face Sensation in six areas and movement in four areas Alorg the medulla VII Facial Face VIII Acoustic Ear Hearing IX Glossal-pharyngeal Mouth Tongue movement, gag and swallow X Vagus Mouth XII Hypoglossal Mouth XI Spinal Accessory Neck Shrug shoulders or move head from side to side against resistance Table created by Charlotte McCallum based on information from Bickley & Szilagyi, 2009.
13) However, brain MRI is usually not necessary if there is a post lumbar puncture headache, being indicated only when headache is accompanied by abducens
nerve palsy, lumbar radiculopathy or diagnostic confusion as a result of neck stiffness.
Cranial osteopathy focused on the sphenobasilar joint and the most likely places for intracranial entrapment neuropathy of oculomotor, trochlearis, and abducens
nerves, which regulate intra- and extraocular muscles.
Headache associated with papilloedema and an abducens
palsy as the only abnormal neurological finding is a common presentation of benign intracranial hypertension.
Left acoustic (VIII) and facial (VII) cranial nerve palsies occurred initially, followed by trigeminal (V), abducens
(VI) glossopharyngeal (XI), vagal (X), accessory (XI), and hypoglossal (XII) left sided cranial nerve palsies.
nerve palsy was the most common cranial nerve impairment (9,33).
Lateral to the sella, the cavernous sinuses contain the internal carotid arteries and the oculomotor, trochlear, abducens
, and first division of the trigeminal nerves.
On the seventh day of treatment, the patient rapidly deteriorated, symptoms of fever, headache and neck tiffness ensued with the development of anisocoria and left abducens
Ophthalmological examination revealed bilateral abducens
paresis and optic disc edema in the left eye.