Abducens Cranial Neuropathy
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This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0480-Abducens Cranial Neuropathy
CA0480-Abducens Cranial Neuropathy
Case ReportHistory
Exam
Prior Study
Findings
Brain and Brainstem
The region of the third, fourth and/or sixth cranial nerve nucleus, the median longitudinal fasciculus and the respective tracts of all 3 cranial nerves within the brainstem to their root entry zones is normal.
General Meninges, Cisternal Segment and Root Entry Zone
There is no abnormal generalized meningeal (dural and/or pia-arachnoid) enhancement is not present. The pia/arachnoid surface at the root exit zone of the third, fourth and/or sixth cranial nerve is normal and there is no abnormal enhancement, enlargement or structural abnormality involving the cisternal segment of the third, fourth and/or sixth cranial nerve.
There is no posterior communicating or other cerebral aneurysm along the cisternal segment of the third, fourth and/or sixth cranial nerve.
Cavernous sinus and Paracavernous Structures
There is prominent abnormal enhancement surrounding the expected course of the 3rd, 4th and 6th cranial nerve in the cavernous sinus and paracavernous region. This enhancement appears to be ill-defined at some points and involved both the medial and lateral dura of the cavernous sinus and be present within the cavernous sinus itself. A T2-weighted images the tissue here and at the orbital apex appears of relatively low signal intensity, suggesting a possible fibrous reactive component although such signal characteristics are not tissue specific. Signal change such as seen on the T2-weighted images is somewhat more typical of pseudo-tumor or invasive fungal disease rather than tumor.
Orbit, Extraocular Muscles, Sinonasal Region and Skull Base
The orbital apex it is infiltrated as seen on both T1 and T2-weighted images with an enhancing ill-defined process. The extraocular muscles at the orbital apex in the posterior 3rd of the orbit are edematous and enhance abnormally. The intraconal and/or extraconal orbital fat is infiltrated at the orbital apex and along the optic sheath just distal to the orbital apex.
There is no pathologic process arising within the orbit, sinonasal structures or skull base that might produce secondary loss of normal ocular motility or vision by involving extraocular muscles. There is some mucosal thickening in the left side of the sphenoid sinus, but this is not likely causative pathology.