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• W1977920863 abstract "We report on a 48-year-old man who had suffered a head trauma. This entailed a concussion with small bleedings in the brainstem and in the left hemisphere, as well as a subarachnoidal bleeding. He also sustained a fracture of C1. When he first presented to our clinic 6 weeks after the trauma, both eyes could not abduct past midline. This indicated an injury of both VI nerves. At follow-up 6 months later, the right eye could still not abduct past midline, while the left eye had recovered partially to abduct 3 mm (limbus test according to Kestenbaum). Adduction was slightly impaired on the right side. The patient reported to have undergone injections with botulinum toxin into both medial rectus muscles 4 months previously, which was repeated on the right side only 3 weeks prior to our second examination. In order to assess timing and approach of a possible eye muscle surgery a magnetic resonance imaging (MRI) scan with special attention placed on the abducens nucleus and nerve was performed. On the right side, there was an interruption in the continuity of the right VI nerve just in front of the paramedian brainstem. There was no connection to its nuclear origin in the right pontomedullary area, consistent with a unilateral avulsion resulting in an absolute VI nerve palsy (Fig 1A; available at http://aaojournal.org). The left VI nerve could be seen continually, exiting from its pontomedullary origin, suggesting a VI nerve pareses on the left side (Fig 1B; available at http://aaojournal.org). For confirmation, an oculodynamic MRI (od-MRI) as described by Palmowski et al1Palmowski-Wolfe A. Kober C. Berg I. et al.Globe restriction in a severely myopic patient visualized through oculodynamic magnetic resonance imaging (od-MRI).J AAPOS. 2009; 13: 322-324Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar was added to the conventional MRI scan to examine horizontal eye movements with active eye movement. The patient was asked to look from the right to the left as far as possible. Meanwhile axial T2/T1 weighted MR images with 5-mm slice thickness were acquired (180 ms/image, 1.3×1.3 mm spatial resolution) that were looked at in cine mode for the assessments of horizontal eye movements. The od-MRI showed no active lateral rectus muscle contraction on the right side confirming a complete VI nerve palsy on the right. Consistent with the clinical examination, which now showed a little abduction on the left side, oculodynamic MRI could demonstrate a very small contraction of the left lateral rectus muscle consistent with a VI nerve paresis, suggesting a good potential for recovery (Video 1; available at http://aaojournal.org). In addition, while there is good contraction in both medial rectus muscles this appears slightly less on the right side following botulinum toxin injection into this muscle 3 weeks earlier. Thus, oculodynamic MRI which only involves an additional 30 seconds added on to a conventional MRI scan is a powerful noninvasive tool providing valuable additional prognostic information. Download .mpg (2.14 MB) Help with mpg files Video 1VidClip of the oculodynamic magnetic resonance imaging (MRI) shows no contraction of the right lateral rectus in attempted abduction while, on abduction, the left lateral rectus contracts slightly. Although there is good contraction in both medial rectus muscles, this appears slightly less on the right side following botulinum toxin injection into this muscle 3 weeks earlier." @default.
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• W1977920863 date "2010-02-01" @default.
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• W1977920863 title "Bilateral VI Nerve Injury" @default.
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• W1977920863 doi "https://doi.org/10.1016/j.ophtha.2009.10.035" @default.
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