Spontaneous resolution of sixth nerve palsy with ipsilateral cavernous carotid dolichoectasia

• Published in: British journal of ophthalmology Vol. 88; no. 4; pp. 586 - 587
• Main Author: Foroozan, R
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.04.2004; BMJ Publishing Group LTD; Copyright 2004 British Journal of Ophthalmology
• Subjects: Abducens Nerve Diseases - complications; Abducens Nerve Diseases - pathology; Aged; Blood clots; Carotid arteries; Carotid Artery, Internal - pathology; Dilatation, Pathologic; Humans; ipsilateral; Letter; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; NMR; Nuclear magnetic resonance; Patients; Remission, Spontaneous; sixth nerve palsy; Surgery; Veins & arteries
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2003.027862

Arteriosclerosis, with thinning of the media and defects in the internal elastic laminae of the vessel walls, is thought to predispose to progressive enlargement of the vessel lumen. 1 Ectasia of the intracranial arteries is believed to cause symptoms because of compression of adjacent structures and/or ischaemia secondary to intraluminal thrombus formation and blockade of perforating vessels along the length of the dolichoectatic vessel. 1 Dolichoectasia of the cavernous carotid artery has been suggested as an infrequent cause of sixth nerve paresis. Ischaemia of the vaso vasorum of the sixth nerve, perhaps because of intraluminal thrombus formation, may have resulted in a vasculopathic sixth nerve palsy, but there was no evidence of thrombus formation on the MRI/MRA. Because the causative mechanism in patients with persistent sixth nerve paresis from presumed dolichoectasia is not certain treatment guidelines are not clear.