Isolated abducens nerve palsy with hyperhomocysteinemia: Association and outcomes

Abstract

Ischemic abducens nerve palsy usually presents as isolated cranial nerve palsy in the middle aged and elderly patients with known risk factors such as diabetes mellitus, hypertension, dyslipidemia, carotid artery disease, etc., In this report, we describe four patients with isolated abducens nerve palsy who presented with an acute onset diplopia whose detailed history and examination were suggestive of an ischemic etiology. Detailed systemic and laboratory evaluation revealed hyperhomocysteinemia as the only potential risk factor. To the best of our knowledge this is the first report of association of hyperhomocysteinemia and isolated abducens nerve palsy.

Eicosapentaenoic Acid for Diabetic Abducens Nerve Palsy

“…Although the cause of diabetic abducens nerve palsy has been unknown, atherosclerotic risk factors such as diabetes, hypertension, hyperlipidemia and hyperhomocysteinemia, and thrombosis have been reported to be associated with the development of diabetic abducens nerve palsy [2][3][4][5]. Pain which was also observed in our patient, has been suggested to be a common feature of microvascular ischemic ocular motor cranial nerve palsies [6], supporting a significance of atherosclerosis and thrombosis for the pathogenesis of diabetic abducens nerve palsy.…”

Sixth Cranial Nerve Palsy and Vertigo Caused by Vertebrobasilar Insufficiency

“…The presentation of myasthenia gravis in an isolated sixth cranial nerve palsy has been reported [1]. Infectious mononucleosis can precede isolated abducens nerve palsy, as an association between hyperhomocysteinemia and isolated abducens nerve palsy is known [15,16]. To exclude these causes related to anemia in our patient, we performed several tests, which showed negative results.…”

Ocular Morbities Associated With Hyperhomocystenemia

“…Increased plasma homocysteine is associated with both retinal vein and retinal artery occlusion and the elevation being greater in vein occlusion. 7 In a case series presented by Virendra Sachdeva et al, 8 from LVPEI, India 4 cases of isolated abducent nerve palsy was associated with hHcy. However we did not come across any such cases.…”