Article type: Case Report
Article title: Isolated pseudo‑abducens palsy and contralateral occipital headache with thalamic stroke: A case report and mini‑review of the literature
Journal: Medicine International
Year: 2024
Authors: Jamir Pitton Rissardo, Hossam Tharwat Ali, Asad Riaz, and Ana Leticia Fornari Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
The abducens nerve (sixth cranial nerve) is essential for lateral eye movement, and its malfunction can cause a variety of issues with vision. Pseudo‑abducens palsy is a rare neurological condition that causes a limitation in eye abduction, while the abducens nerve is still functioning. Thalamic pain syndrome, a severe complication of cerebrovascular events, presents as intense neuropathic pain provoked by temperature fluctuations. Although thalamic strokes are infrequently associated with ocular abnormalities, some studies suggest an association between isolated pseudo‑abducens palsy and thalamic infarctions. The present study describes the case of a 38‑year‑old male patient with 1‑day progressive diplopia and occipital headache who had abducens palsy on the left side as a result of a right thalamic infarction. The patient had a 10‑year history of smoking and a 1‑year history of hypertension, which was poorly controlled. The diagnosis was supported by a neurological examination, imaging and stroke etiology investigations. The patient recovered well within 5 days, highlighting the good prognosis of an acute thalamic presentation. In addition, a mini‑review of the literature was performed and two similar reports were identified upon searching the literature using the Embase, Google Scholar, Lilacs, Medline, SciELO and ScienceDirect databases. On the whole, the present study demonstrates that understanding the complex neuronal connections inside the thalamus is critical for a proper diagnosis and appropriate intervention strategies in patients with thalamic stroke with oculomotor impairments. Further research is required to elucidate the underlying causes and develop treatment techniques for thalamic infarction consequences.
Keywords: pseudo‑abducens palsy, sixth nerve palsy, abducens palsy, thalamic stroke, thalamic pain syndrome, stroke
Full text available at:
DOI
Citation
Rissardo JP, Ali HT, Riaz A, and Caprara AL. Isolated pseudo‑abducens palsy and contralateral occipital headache with thalamic stroke: A case report and mini‑review of the literature. Med Int 2024;4:18. https://doi.org/10.3892/mi.2024.142
Table I. Case reports of individuals who developed isolated pseudo‑abducens palsy secondary to a thalamic stroke.
Figure 1. Neuroimaging illustrating thalamic infarction (arrow). (A) Level of the lower midbrain, (B) level of the upper midbrain, and (C) level of the lower basal ganglia images of an axial cranial computed tomography scan.
Figure 2. Schematic diagram illustrating the possible mechanisms of the isolated thalamic infarction causing pseudo‑abducens palsy. First, the inhibitory convergence pathway begins in the frontal and supplementary eye field in the motor cortex. Second, the pathway passes through the thalamus and decussates in the subthalamic region. Third, the inhibitory convergence pathway possibly controls the third cranial nerve nucleus localized in the midbrain. 3rd CNN, third cranial nerve nucleus.