The authors present the clinical findings of a 30-year-old female and a 29-year-old male who both had isolated unilateral lateral rectus muscle palsy in neuro-Behcet's disease. The clinical feature related to isolated abduscens nerve palsy was identified by CT, systemic assessment and extraocular examination. These patients' constellation of findings appear to be unique: it does not follow any previously reported pattern of ocular manifestations of neuro-Behcet's disease.
Abducens Nerve/physiopathology ; Adult ; Behcet's Syndrome/complications* ; Case Report ; Eye Movements/physiology ; Female ; Human ; Male ; Ophthalmoplegia/physiopathology ; Ophthalmoplegia/etiology* ; Paralysis/physiopathology ; Paralysis/etiology*

Carotid cavernous dural arteriovenous fistula (DAVF) usually presents with conjunctival injection, proptosis, loss of visual acuity and ophthalmoplegia. There have been some carotid cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We experienced a patient presenting with bilateral abducens nerve palsy and no other ocular signs who was diagnosed as carotid cavernous DAVF after conventional angiography. According to this case, carotid cavernous DAVF should be considered in the differential diagnosis of isolated bilateral abducens nerve palsy, in which case conventional angiography may be helpful in diagnosis.
Abducens Nerve/physiopathology* ; Arteriovenous Fistula/complications* ; Carotid Artery Diseases/complications* ; Case Report ; Cavernous Sinus*/radiography ; Cranial Nerve Diseases/physiopathology ; Cranial Nerve Diseases/etiology ; Dura Mater/blood supply* ; Female ; Human ; Middle Age ; Paralysis/physiopathology ; Paralysis/etiology*

A 51-year-old woman with breast cancer presented with progressive diplopia. Neuro-ophthalmologic examination revealed right gaze palsy and peripheral facial nerve palsy. Brain magnetic resonance imaging (MRI) was normal. However, two months later a repeat brain MRI revealed an enhancing round nodular mass at the right facial colliculus of the lower pons, at the location of the abducens nucleus. Localized metastasis to the abducens nucleus can cause gaze palsy in a patient with breast cancer.
*Abducens Nerve Diseases ; Breast Neoplasms/*pathology ; Cranial Nerve Neoplasms/*complications/*secondary ; Facial Paralysis/complications ; Female ; Fixation, Ocular ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Ocular Motility Disorders/*etiology/physiopathology ; Pons/pathology

We report a case of multiple myeloma that presented as a fluctuating sixth cranial nerve palsy in the absence of widespread signs of systemic disease. A 63-year-old woman presented with horizontal diplopia of two weeks duration that subjectively changed over time. Ocular examination showed a fluctuating sixth nerve palsy. A computed tomography (CT) scan of the brain showed multiple, enhancing, soft tissue, mass-like lesions involving the left cavernous sinus and the apex of both petrous bones. Based on bone marrow biopsy and hematologic findings, she was diagnosed with multiple myeloma. Multiple myeloma may be included in the differential diagnosis of a fluctuating sixth nerve palsy, and although ophthalmic signs are rare and generally occur late in the course of multiple myeloma, they can still be its first signs.
Abducens Nerve Diseases/diagnosis/*etiology ; Brain/pathology/radiography ; Diagnosis, Differential ; Diplopia/etiology ; Esotropia/etiology/physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Multiple Myeloma/*complications/diagnosis ; Tomography, X-Ray Computed