Case Reports in Otolaryngology

Case Report

Abducens Nerve Neuropraxia due to Acute Bacterial Rhinosinusitis: Case Report and Literature Review

Table 1

Summary of cases of abducent nerve palsy secondary to sinus pathology in the literature.
StudyEtiologyPresentationLateralityClinical grading system†ManagementPrognosisTime to resolution
Miller et al. [6]AFRSDiplopiaBilateralGrade 2SurgeryComplete recovery2 weeks
AFRSDiplopiaRightGrade 2SurgeryComplete recovery2 weeks
AFRSDiplopiaLeftGrade 2Surgery, steroids, and oral antibioticsPartial recovery1 month
ABRSDiplopiaRightGrade 2Surgery and intravenous antibioticsPartial recovery34 days
Gupta et al. [22]ABRSDiplopia, headache and feverLeftGrade 2Surgery and intravenous antibioticsComplete recovery2 days
Kordrostami and Parmar [23]ABRSDiplopia and visual lossRightGrade 4Surgery and intravenous antibioticsFull improvement of visual acuity with preset of sixth-nerve palsy2 months
Mograbi and Soudry [24]ABRSDiplopiaRightGrade 2Surgery, steroids, and oral antibioticsComplete recovery1 month
CRSDiplopiaLeftGrade 2Surgery and antibioticsComplete recovery2 weeks
Ada et al. [25]ABRSDiplopia and headacheRightGrade 2Antibiotics and steroidsComplete recovery2 weeks
Lee et al. [20]Chronic invasive fungal sinusitisDiplopiaBilateralGrade 2Surgery and antifungal treatmentComplete recovery17 months
Sphenoid sinus fibrosisDiplopiaLeftGrade 2Surgery and antibioticsNo resolutionNo resolution
Fungal ballDiplopia and headacheLeftGrade 2SurgeryComplete recovery1 month
ABRSRetroorbital pain and progressive diplopiaLeftGrade 2Surgery and antibioticsComplete recovery4 months
Fockaert et al. [26]AFRSDiplopia and retroorbital painLeftGrade 2SurgeryComplete recovery1 month
Siu et al. [27]ABRSDiplopia and headacheRightGrade 2Surgery and antibioticsComplete recovery6 weeks
Safouris et al. [28]ABRSDiplopia and headacheLeftGrade 2Antibiotics and steroidsComplete recovery2 weeks
Del Brutto and Caputi [29]ABRSDiplopia and headacheLeftGrade 2AntibioticsComplete recovery3 weeks
Mubaidin and Hairi [7]ABRSFever, diplopia and headacheBilateralGrade 2AntibioticsComplete recovery4 weeks
Harugop et al. [21]Fungal ballFever, diplopia and headacheLeftGrade 2Surgery, intravenous antibiotics, and local anti-fungal treatmentComplete recovery12 weeks
NRDecrease vision, fever and diplopiaRightGrade 2Surgery and anti-fungal treatmentPartial recovery12 weeks
Trinidade et al. [30]Fungal ballDiplopiaRightGrade 2SurgeryComplete recovery3 weeks
Ceylan et al. [31]CRSDiplopia and headacheBilateralGrade 2Surgery, steroids, and oral antibioticsComplete recovery6 weeks
Lapusneanu et al. [32]ABRSDiplopia and headacheRightGrade 2Surgery, steroids, and oral antibioticsComplete recovery1 month
Giordano et al. [33]ABRSDiplopia, ptosis and headacheLeftGrade 2Surgery and intravenous antibioticsComplete recovery4 days
Vazirnezami et al. [34]AFRSDiplopia and headacheRightGrade 2SurgeryComplete recovery5 weeks
Muneer and Jones [35]MucoceleDiplopia and headacheRightGrade 2Surgery, steroids, and oral antibioticsComplete recovery2 days
MucoceleDiplopia and periorbital cellulitisRightGrade 2Surgery and steroidsComplete recovery2 days
MucoceleDiplopiaRightGrade 2SurgeryComplete recovery1 day
Geçirilmesi [36]MucoceleDiplopiaRightGrade 2SurgeryPartial recovery6 months
Hill et al. [37]MucoceleDiplopia, headache and blurred vision,RightGrade 4Surgery and antibioticsThe third nerve palsy had resolved. There was no change in his visual acuity however3 months
MucocelePtosis, diplopia and headacheLeftGrade 2SurgeryMinimal residual third nerve weakness1 year
AFRS: allergic fungal rhinosinusitis, ABRS: acute bacterial rhinosinusitis. †: clinical grading system is adapted from Al Anazy and Al-Dousary’s classification system [38].