Palsy of the abdomen

As Palsy of the abdomen is the term used to describe paralysis of the sixth cranial nerve, which is usually based on compression. Squinting and double vision shape the clinical picture. Treatment depends on the cause.

What is abductor palsy?

The paralysis of the sixth cranial nerve, which is usually based on compression, is referred to as palsy of the abdomen. Of the Abducens nerve is also called VI.Known cranial nerve and is composed of motor fibers that make up the Lateral rectus muscle innervate the eye. This muscle moves the eye axis to the side, which is also known as abduction. In its core area the nerve runs as Nucleus nervi abducentis by the Tegmentum pontis, so the bridge hood. Via the clivus on the occiput he reaches the Cavernous sinus and the Superior orbital fissurefrom where it runs into the anulus tendineus communis and the orbit.

Like all other nerves, this nerve can also be affected by paralysis. The paralysis of the abducens nerve is also called Palsy of the abdomen known and manifests itself in an inability to move the eyes outwards, which is caused by the inability of the lateral rectus muscle to move. In addition to a complete loss of function of this muscle, partial loss of function in the context of an abdominal palsy is also conceivable. However, with the paralysis, the molecular field of vision is always limited. A palsy of the abdomen is either monolateral or bilateral.

causes

If the abducens nerve fails, the affected eye hangs after the healthy eye when looking sideways. This phenomenon is mostly caused by local compression of the nerve, which often occurs as part of inflammation at the base of the skull. Cavernous sinus syndrome following cavernous sinus thrombosis is one of the most common causes.

Primary diseases such as meningitis or aneurysms and arteriovenous fistulas can also be associated with palsy of the abdomen. The same goes for infections like syphilis, sarcoid, or Lyme disease. Tumors of the base of the skull or of the nasopharynx can also be the causative masses that can trigger palsy of the abdomen. Compressions of the abducent nerve can also be caused by increased intracranial pressure in the context of Wernicke-Korsakoff syndrome or by trauma.

If a brainstem injury causes palsy of the abdomen, other cranial nerves are usually affected. Side paralysis alone is therefore not particularly characteristic of brain stem lesions. In the case of bilateral palsy of the abdomen, causal masses are less likely than primary diseases.

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Symptoms, ailments & signs

The paralysis of the abducens nerve alleviates this Lateral rectus muscle either fully or partially the function. As a result, the equilateral antagonist of this muscle shows excessive activity. The opposite of the lateral rectus muscle is the Medial rectus muscle. Its hyperfunction causes the affected eye to squint inwards with a slightly smaller close squint angle compared to the remote squint angle.

The secondary angle of the affected eye is larger than the primary angle and the squint angle changes its size with the direction of gaze. The main symptom of a palsy of the abdomen is, in addition to the squint, a restriction in the monocular field of vision, which is usually in the direction of muscle pull. In this context, double images appear, which show increasing distance in the direction of the paralyzed eye. To avoid double vision, patients with abducens palsy often adopt an obsessive head position and obsessively turn their head to the affected side. In the case of bilateral palsy of the abdomen, double vision does not occur when looking into the distance.

Diagnosis & course

The diagnosis of palsy of the abdomen can often be made by the ophthalmologist based on the clinical picture and anamnesis. However, neurological tests are essential to determine the cause. Imaging of the brain and the structures close to the brain helps to assess the symptoms of paralysis and to clarify the cause.

The Stilling-Türk-Duane syndrome, which is also associated with a lesion of the abducens nerve, should be considered in the differential diagnosis. The syndrome, however, is anchored in an additional malnervation of the lateral rectus muscle and thus usually has its own symptoms. The course of an abducent nerve palsy depends on the cause and the duration of the triggering nerve compression. Long-lasting compressions can, for example, permanently damage the nerve and cause irreversible loss of function.

Complications

The palsy of the abdomen can be congenital or accident-related, but can also arise from various circumstances with increasing age. The pathogenesis suggests a problem with the sixth cranial nerve. The visual axis is differentiated. Squinting results in limited or no spatial vision. The surgical procedure helps to restore the ability to see and to rule out subsequent complications as far as possible.

The palsy of the abdomen, which occurs in childhood, is partly hereditary. Making use of the correction option in the first years of childhood is crucial for a symptom-free growth. If the deformity is not treated early enough, eye movement will be impaired.

Disturbances in perception and the inability to process the image information lead to severe deficits for the child. The brain hides the optic nerve through the constantly supplied double images. The poor eyesight becomes irreparable. Adults can be affected by the diagnosis after a stroke, with multiple sclerosis, diabetes mellitus and tumor formation.

Depending on the course of the disease, complications such as hearing loss, fever attacks, facial weakness, nausea and headaches can occur. The surgical procedure can largely correct the malposition. Sometimes it is necessary to have several surgical sessions. This can result in complications in the form of secondary bleeding or infection. During the procedure, only the optimal compensation of the squint angle can be produced, but not an associated ametropia.

When should you go to the doctor?

If someone suddenly has an inward squint and double vision, it is always advisable to see a doctor. In addition to many other possibilities that trigger such symptoms, it can be a palsy of the abdomen. It is important to investigate the possible causes of these symptoms as they cannot be classified as harmless.

The symptoms of abdominal palsy suggest a serious condition. What is difficult is that the triggers of a palsy of the abdomen are not always noticed immediately. The abdomen palsy can be triggered by unnoticed processes elsewhere and cause various neurological disorders. A visit to the doctor is mandatory due to the symptoms that occur.

Even if the symptoms sometimes go away on their own because the problem that caused the problem has resolved itself, you should not be afraid to seek medical advice. In most cases it is not a question of the consequences of a short-term circulatory disorder. It is important for those affected that they risk permanent compression of a nerve in the brain without a doctor's visit.

Usually the ophthalmologist is consulted first based on the symptoms. If necessary, he will refer you to a specialized practice for computer-aided examinations with imaging methods. For older diabetics, an internist is the right address. Treatment of diabetes can also cure palsy of the abdomen.

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Treatment & Therapy

The treatment of palsy of the abdomen depends on the cause and is initially purely neurological or neurosurgical. The causal treatment is to be given priority. Symptomatic treatment is only given after masses have been removed or inflammatory triggers have healed. If the squint does not decrease significantly in up to a year, a squint operation is usually performed. Squint operations shift the field of binocular single vision into the primary position.

A forced head posture for simple viewing is no longer necessary due to the relocated and possibly enlarged field. If the eye can move up to the midline, a combined operation is usually carried out that strengthens the lateral rectus muscle and at the same time weakens its antagonist. The weakening of the muculus rectus medialis takes place through repositioning or through Cüpper's thread surgery. The eye muscle paresis is transformed into an artificially induced visual paralysis with a reduced secondary angle.

By guiding the healthy eye, an increase in the innervation of the paralyzed muscle is achieved so that the primary angle changes. A second possibility of intervention are muscle transpositions. Such displacements of the muscle attachment are usually only recommended if the paralyzed eye can hardly leave the nasal corner of the eyelid due to a complete abdominal paralysis. If, on the other hand, the paresis is extremely subtle, conservative methods such as prism lenses can improve the patient's visual situation.

Outlook & forecast

In most cases, the palsy of the abdomen leads to considerable restrictions and discomfort for the patient. Above all, paralysis and other disorders of sensitivity occur, which complicate the everyday life of the person concerned and thus reduce the quality of life. Furthermore, discomfort can also arise in the eyes, so that those affected suffer from double vision, strabismus or what is known as veiled vision.

The paralysis can lead to balance disorders or restricted mobility. It is not uncommon for patients to have to rely on the help of other people in everyday life due to palsy of the abdomen in order to be able to continue mastering it. In children, palsy of the abdomen can lead to delayed development and thus to symptoms in adulthood.

The palsy of the abdomen must be treated causally in order to limit all symptoms. In most cases, surgery leads to a positive course of the disease. This means that paralysis and discomfort in the eyes can be permanently removed. The life expectancy is not reduced by the palsy of the abdomen. Without treatment, there is usually no spontaneous healing.

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prevention

Since an abducent nerve palsy can be present in the context of various primary diseases and even after accidents, the symptom of paralysis can hardly be actively prevented.

Aftercare

Follow-up care options are often not available in the case of palsy of the abdomen. The affected person is dependent on treatment to permanently alleviate the symptoms. However, the treatment depends heavily on the exact cause of the abdomen palsy, so that no general prediction can be made about the success and course of the disease.

However, the life expectancy of the patient is usually not restricted or reduced by the palsy of the abdomen. In most cases, palsy of the abdomen is treated by surgery. There are no particular complications and mostly a success, so that the symptoms are completely alleviated.

After such an operation, the eyes must be spared, so a bandage should also be worn around the eyes. Likewise, the person concerned should not strain the body unnecessarily and not expose it to unnecessary stress. The wound must be kept sterile and clean to prevent inflammation.

The affected person may also be dependent on taking antibiotics due to the palsy of the abdomen. Smoking and alcohol consumption should also be avoided. A healthy diet can also have a positive effect on the course of the abdomen palsy.

You can do that yourself

In the case of sudden visual disturbances, especially if these are accompanied by an inward squint or the perception of double vision, an ophthalmologist must be consulted. This also applies if the symptoms go away on their own. Without professional treatment, the person concerned risks permanent compression of a cranial nerve.

What patients can do themselves depends on the type of underlying disease. If meningitis, Lyme borreliosis or syphilis are the cause of the impairment of a nerve in the brain, a good constitution and the strengthening of the body's immune system contribute to rapid convalescence.

A vitamin-rich, plant-based diet, avoiding red meat and sausage products and large amounts of refined sugar, which is particularly found in soft drinks, are helpful here. White flour products should also be avoided and whole grain products should be preferred instead. The consumption of too much alcohol and cigarettes is also counterproductive.

If the paralysis leads to balance disorders or restricted mobility, those affected should seek help in coping with everyday life. Using a wheelchair or an assistant can help ensure that those affected do not injure themselves from falls. Patients should also not be afraid to ask their immediate social environment and the employer for help. The adaptation of work activities and the workplace is usually at least temporarily unavoidable.