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Clinical presentation of pseudo-abducens palsy
Maya Sinulingga Reid1, Scott Alan DePoe, Reagan Lorena Darner
1*OD, FAAO †OD Salem Veterans Affairs Medical Center, Salem, Virginia (all authors); and Virginia Tech Carilion School of Medicine, Roanoke, Virginia (WSS).
Summary
Pseudo-abducens palsy, a rare condition, involves impaired lateral eye movements despite an intact abducens nerve. This case highlights its distinction from infranuclear palsy, suggesting supranuclear pathway dysfunction.
Area of Science:
- Neuro-ophthalmology
- Neurology
Background:
- Pseudo-abducens palsy is a rare neurologic condition characterized by impaired abduction during voluntary eye movements, despite an intact abducens nerve.
- The vestibulo-ocular reflex (VOR) remains unaffected, indicating the abducens nerve's integrity and suggesting a supranuclear cause.
Observation:
- A 63-year-old man presented with sudden horizontal diplopia and restricted abduction in the left eye during pursuits.
- Intermittent spasm of the right medial rectus was noted. The VOR, stimulated via the doll's head maneuver, showed full abduction, contrasting with the impaired voluntary movement.
Findings:
- The patient's presentation, including intact VOR, impaired abduction on pursuits, and contralateral esotropia, led to a diagnosis of pseudo-abducens palsy.
- This case supports the theory that pseudo-abducens palsy involves a dysfunctional supranuclear vergence pathway.
Implications:
- Differentiating pseudo-abducens palsy from classic abducens infranuclear palsy is crucial for accurate diagnosis and treatment.
- Understanding the supranuclear origin of pseudo-abducens palsy is essential for managing patients with such complex eye movement disorders.
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