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PICTURES IN CLINICAL MEDICINE
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Infarction of the Abducens Nucleus and Facial Nerve Hiromasa Tsuda, Ei-ichi Nakao and Masaki Ishihara Key words: abducens nerve, internuclear ophthalmoplegia, medial longitudinal fasciculus, pons, skew deviation (Intern Med 54: 539-540, 2015) (DOI: 10.2169/internalmedicine.54.3696)
Picture 1.
Picture 2.
A 58-year-old man with diabetes mellitus abruptly developed left-sided peripheral facial palsy, abduction paresis of the left eye and concomitant skew deviation with left-sided hypertropia (Picture 1). There were no other neurologic ab-
normalities. The findings of an electrocardiogram, echocardiogram, carotid ultrasonography and cranial magnetic resonance (MR) angiography were normal. Cranial MR imaging demonstrated localized infarction in the left-sided most dor-
Department of Neurology, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Japan Received for publication July 17, 2014; Accepted for publication August 21, 2014 Correspondence to Dr. Hiromasa Tsuda, [email protected]
539
Intern Med 54: 539-540, 2015
DOI: 10.2169/internalmedicine.54.3696
sal region of the pontine tegmentum (Picture 2, A: fluidattenuation inversion recovery, B: diffusion-weighted, C: apparent diffusion coefficient, arrows) involving the genu of the facial nerve and posterior region of the abducens nucleus. A diagnosis of atherothrombosis was suspected, and treatment with an anti-platelet agent was administered. Thereafter, the patient’s ophthalmoplegia resolved within five days and the facial palsy was ameliorated within ten days. Pontine lesions often cause concomitant skew deviation (1). The topographical localization of the abducens nerve and medial longitudinal fasciculus in the abducens nu-
cleus remains uncertain. In our patient, abducens nerve palsy developed without internuclear ophthalmoplegia. Therefore, the abducens nerve may derive from the posterior region of the abducens nucleus. The authors state that they have no Conflict of Interest (COI).
Reference 1. Keane JR. Ocular skew deviation. Analysis of 100 cases. Arch Neurol 32: 185-190, 1975.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
540
PICTURES IN CLINICAL MEDICINE
□
Infarction of the Abducens Nucleus and Facial Nerve Hiromasa Tsuda, Ei-ichi Nakao and Masaki Ishihara Key words: abducens nerve, internuclear ophthalmoplegia, medial longitudinal fasciculus, pons, skew deviation (Intern Med 54: 539-540, 2015) (DOI: 10.2169/internalmedicine.54.3696)
Picture 1.
Picture 2.
A 58-year-old man with diabetes mellitus abruptly developed left-sided peripheral facial palsy, abduction paresis of the left eye and concomitant skew deviation with left-sided hypertropia (Picture 1). There were no other neurologic ab-
normalities. The findings of an electrocardiogram, echocardiogram, carotid ultrasonography and cranial magnetic resonance (MR) angiography were normal. Cranial MR imaging demonstrated localized infarction in the left-sided most dor-
Department of Neurology, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Japan Received for publication July 17, 2014; Accepted for publication August 21, 2014 Correspondence to Dr. Hiromasa Tsuda, [email protected]
539
Intern Med 54: 539-540, 2015
DOI: 10.2169/internalmedicine.54.3696
sal region of the pontine tegmentum (Picture 2, A: fluidattenuation inversion recovery, B: diffusion-weighted, C: apparent diffusion coefficient, arrows) involving the genu of the facial nerve and posterior region of the abducens nucleus. A diagnosis of atherothrombosis was suspected, and treatment with an anti-platelet agent was administered. Thereafter, the patient’s ophthalmoplegia resolved within five days and the facial palsy was ameliorated within ten days. Pontine lesions often cause concomitant skew deviation (1). The topographical localization of the abducens nerve and medial longitudinal fasciculus in the abducens nu-
cleus remains uncertain. In our patient, abducens nerve palsy developed without internuclear ophthalmoplegia. Therefore, the abducens nerve may derive from the posterior region of the abducens nucleus. The authors state that they have no Conflict of Interest (COI).
Reference 1. Keane JR. Ocular skew deviation. Analysis of 100 cases. Arch Neurol 32: 185-190, 1975.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
540
