Unilateral Abducens Nerve Palsy in Increased Intracranial Pressure Caused by Brain Neoplasm

Zei-Lun Huang ^a, Chen-Nen Chang ^b, Min-Muh Sheu ^a, Rong-Kung Tsai ^a

^aDepartment of Ophthalmology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^bFirst Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

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Abstract

A 45-year-old woman with a 2-year history of chronic headaches and intermittent transient obscured vision presented with acute onset of diplopia for 2 weeks. Ophthalmologic examination showed esotropia due to right abducens nerve palsy and bilateral chronic papilledema. Brain magnetic resonance imaging demonstrated a meningioma in the left parasagittal frontal region causing a right shift of the anterior midline and compression of the lateral ventricle. The tumor was completely removed and her diplopia and esotropia disappeared. At the 2-month follow-up, papilledema had subsided. Acute onset of esotropia resulting from right abducens nerve palsy may be an ominous sign of brain tumor.

keywords

Abducens nerve palsy; Esotropia; Increased intracranial pressure (IICP); Meningioma