sixth nerve palsy
What is an abduction paresis?Abduction paresis is the paralysis of the sixth cranial nerve, which is usually based on compression. The Nervus abducens is also called VI. Cranial nerve is known and is composed of motor fibers that innervate the lateral rectus muscle of the eye. This muscle moves the axis of the eye to the side, which is also known as abduction. In its core area, the nerve runs as the nucleus nervi abducentis through the pontine tegmentum, ie the bridge cap. Via the clivus at the occiput, it reaches the cavernous sinus and the superior orbital fissure, from where it runs into the annulus tendineus communis and the orbit.
Like all other nerves, this nerve can be affected by paralysis. The paralysis of the abducens nerve is also known as abducens paresis, and manifests itself in an inability to move the eye outward, which is caused by the inability to move of the lateral rectus muscle. In addition to complete functional losses of this muscle, partial loss of function in the context of an abduction paresis is also conceivable. The monocular field of view, however, limits itself with the paralysis phenomenon in any case. An abduction paresis is either monolateral or bilateral.
When the abducens nerve fails, the affected eye hangs on the healthy eye when looking sideways. This phenomenon is usually caused by local compression of the nerve, which often occurs as part of inflammation of the skull base. The cavernous sinus syndrome after thrombosis of the cavernous sinus is one of the most common causes.
Primary diseases such as meningitis or aneurysms and arteriovenous fistulas may also be accompanied by parenchymal palsy. The same is true for infections such as syphilis, sarcoidosis or Lyme borreliosis. Tumors of the skull base or of the nasopharynx as trigger for an abduction paresis are also possible as causative masses. Compressions of the abducens nerve may also be caused by increased intracranial pressure in the context of Wernicke-Korsakoff syndrome or trauma.
When a brainstem injury causes abducens palsy, more cranial nerves are usually affected. A sole lateral paralysis is therefore not particularly characteristic of brainstem lesions. In bilateral abducens paresis, causative masses are less likely than primary diseases.
Symptoms, complaints & signsParalysis of the abducens nerve either completely or partially functions for the rectus lateralis muscle . As a consequence, the equilateral antagonist of this muscle shows exaggerated activity. The antagonist of the Musculus rectus lateralis is the Musculus rectus medialis . Its hyperfunction causes the affected eye inward squint with a slightly closer squint angle compared to the far squint angle.
The secondary angle of the affected eye is greater than the primary angle and the squint angle changes its size with the viewing direction. The main symptom of an abduction paresis is in addition to squinting a limitation in the monocular field of vision, which is usually present in the Muskelzugrichtung. In this context, double images appear, which show increasing distance in the direction of the paralyzed eye. To avoid double vision, the patients of the paroxysmal palsy often take a forced head position and turn their head compulsively to the affected side. In a bilateral abduction paresis, double images do not appear when looking into the distance.
Diagnosis & History
The diagnosis of an abdominal nerve palsy can often be made by the ophthalmologist on the basis of the clinical picture and the anamnesis. However, neurological examinations are indispensable for determining the cause. An imaging of the brain and brain-related structures helps in the assessment of paralysis and the explanation of the cause.
Differential diagnosis includes the Stilling-Türk-Duane syndrome, which is also associated with a lesion of the abducens nerve. However, the syndrome anchors in an additional false innervation of the lateral rectus muscle and thus usually has a completely own symptoms. The course of an abduction paresis depends on the cause and duration of the triggering nerve compression. Long-lasting compressions, for example, can permanently damage the nerve and thus cause irreversible loss of function.
The Abduzensparese can be congenital or accidental, but also caused by different circumstances with increasing age. Her pathogenesis indicates a problem with the sixth cranial nerve. The visual axis is differentiated. Squinting results in restricted to no spatial vision. The surgical intervention helps to restore vision and prevent complications as far as possible.
Partially hereditary is the Abduzensparese, which occurs in childhood. Making use of the correction option in the first years of childhood is crucial for a trouble-free growing up. If the malposition is not treated early, impairments in the eye movement occur.
Perceptual disorders and no longer processing the image information can bring the child strong deficits. Through the constantly supplied double images, the brain fades out the optic nerve. The visual impairment becomes irreparable. Adults may be affected by post stroke diagnosis, multiple sclerosis, diabetes mellitus and tumor formation.
Depending on the course of the disease, complications such as hearing loss, fever, weakness of the face, nausea and headache can occur. The surgical intervention can largely correct the deformity. Sometimes several surgery sessions need to be performed. This can cause complications in the form of rebleeding or infection. In the procedure, only the optimal compensation of the squint angle can be made, but not an associated defective vision.
When should you go to the doctor?
If someone suddenly comes to inwardly squinting and seeing double vision, a doctor's visit is always advisable. In addition to many other ways that trigger such symptoms, it may be a Abduzensparese. It is important to investigate the possible causes of these symptoms, as they can not be considered harmless.
The symptoms of gastric paralysis suggest a serious illness. It is difficult that the triggers of an abduction paresis are not always noticed immediately. Abducular palsy can be triggered by unnoticed processes elsewhere and cause various neurological disorders. The visit to the doctor is mandatory because of the symptoms that occur.
Even if the symptoms sometimes disappear by themselves, because the triggering problem has resolved itself, one should not shy away from the medical consultation. In most cases, these are not the consequences of a short-term circulatory disorder. It is important for the person affected that he risks a permanent compression of a nerve in the brain without a doctor's visit.
Usually the ophthalmologist is consulted first because of the symptoms. If necessary, he will then refer computer-assisted imaging examinations to a specialized practice. For older diabetics, an internist is the correct startup address. Treatment for diabetes can also cure abduction paresis.
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Treatment & Therapy
The treatment of an abduction paresis depends on the cause and is initially purely neurological or neurosurgical. The causal treatment is to be given priority. Symptomatic treatment takes place after the removal of masses or the healing of inflammatory triggers. If strabismus does not decrease significantly in up to one year, a strabismus operation is usually performed. Squint operations shift the field of binocular single vision to primary position.
A head compulsory for the sake of simplicity is no longer necessary due to the displaced and possibly enlarged field. When the eye is mobile to the midline, a combined operation is usually performed that strengthens the rectus lateralis muscle and at the same time weakens its antagonist. The weakening of the medulla medulla takes place through remodeling or Cüpper's suture surgery. The ocular muscle palsy is thus transferred to an artificially induced gaze palsy with reduced secondary angle.
By guiding the healthy eye an innervation increase of the paralyzed muscle is achieved, so that the primary angle changes. A second possibility of intervention are muscle transpositions. As a rule, such shifts in the muscular approach are only recommended if the paralyzed eye can scarcely leave the nasal angle of the eyelids due to complete abduction. On the other hand, if the paresis is only subtly pronounced, conservative methods such as prismatic lenses can already improve the person's vision.
Outlook & Forecast
Abduzen nerve palsy causes in most cases considerable limitations and discomfort for the patient. In particular, paralysis and other disturbances of sensitivity occur, which complicate the everyday life of the person concerned and thus reduce the quality of life. Furthermore, complaints to the eyes may arise, so that those affected suffer from double vision, strabismus or the so-called Schleiersehen.
The paralysis can lead to balance disorders or to movement restrictions. Not infrequently, the patients are dependent on the help of other people in everyday life through the Abduzensparese to continue to master this. In children, the paroxysmal eruption can lead to a delayed development and thus to complaints in adulthood.
The Abduzensparese must be treated causally to be able to limit all complaints. In most cases, surgical intervention leads to a positive course of the disease. Thus, paralysis and discomfort to the eyes can be permanently removed. The life expectancy is not reduced by the Abduzensparese. Without treatment, there is usually no spontaneous healing.
Since parenchymal erosion can be present in the context of various primary diseases and even after accidents, the paralysis phenomenon can hardly be actively prevented.
Aftercare options are often unavailable in the case of an abduction paresis. The affected person is dependent on a treatment to relieve the symptoms permanently. However, treatment is highly dependent on the exact cause of abduction, so that no general prognosis can be made about the success and course of the disease.
However, the life expectancy of the patient is usually not limited or reduced by the Abduzensparese. Abduction sclerotherapy is usually treated by surgery. It comes to no special complications and usually to a success, so that the symptoms are completely alleviated.
After such an operation, the eyes must be spared, so that a bandage should be worn around the eyes. Similarly, the person should not unnecessarily strain the body and expose it to unnecessary stress. The wound must be kept sterile and clean in order to prevent inflammation.
Possibly the patient is dependent on the intake of antibiotics by the Abduzensparese. Likewise, smoking and the consumption of alcohol should be avoided. Even a healthy diet can have a positive effect on the course of the paroxysmal eruption.
You can do that yourself
In case of sudden vision problems, especially if they are accompanied by inward strabismus or the perception of double vision, it is essential to consult an ophthalmologist. This is true even if the symptoms disappear on their own. Without professional treatment, the person at risk risks permanent compression of a cerebral nerve.
What patients can do themselves depends on the type of underlying disease. If meningitis, Lyme disease or syphilis are the cause of brain damage, good constitution and strengthening of the body's immune system will contribute to a fast convalescence.
Helpful here are a vitamin-rich, plant-based diet, the renunciation of red meat and sausages and large amounts of refined sugar, which is particularly contained in soft drinks. White flour products should also be avoided and wholegrain products should be favored instead. Also counterproductive is the consumption of too much alcohol and cigarettes.
If the paralysis leads to balance disorders or restricted mobility, those affected should seek help for coping with everyday life. The use of a wheelchair or a helper can help prevent those injured from falling. Patients should not be shy about asking their immediate social environment and employer for help. The adaptation of the work activities and the workplace is usually at least temporarily inevitable.