Case Report Case Report of Progressive Visual Loss and Bilateral Abducens Nerve Palsy: Salvaging a Single Eye
by Reem M Alhammad1*, Sara M Alsubaie2, Ghada B Alghubaini2, Waleed AlRajban3, Ibrahim A Alorainy4
1Department of Internal Medicine, College of Medicine, King Saud University, Saudi Arabia
2Adult Neurology Resident, Department of Internal Medicine, King Saud University, Saudi Arabia
3Pathology Resident, Department of Pathology, King Saud University, Saudi Arabia
4Consultant and Professor of Radiology, Department of Radiology, King Saud University, Saudi Arabia
*Corresponding author: Reem M Alhammad, Consultant Neurologist and Neuromuscular disorders specialist, Assistant Professor of Neurology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Received Date: September 22, 2025
Accepted Date: September 29, 2025
Published Date: October 01, 2025
Citation: Alhammad RM, Alsubaie SM, Alghubaini GB, AlRajban W, Alorainy IA (2025) Case report of Progressive Visual Loss and Bilateral Abducens Nerve Palsy: Salvaging a Single Eye. J Neurol Exp Neural Sci 7: 162. DOI: 10.29011/2577-1442.100062
Abstract
Background: Giant cell arteritis (GCA) can present atypically, complicating diagnosis and management. Case Presentation: A 71-year-old woman with a history of right eye blindness presented with acute visual loss in the left eye and bilateral sixth cranial nerve palsies. Clinical Findings: Initial laboratory tests showed normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Intervention: Empirical glucocorticoid treatment was initiated due to suspicion of GCA. Diagnostic Assessment: Temporal artery biopsy indicated fragmented internal elastic lamina without inflammation. Magnetic resonance angiography (MRA) demonstrated mural thickness and enhancement of the left temporal artery, supporting the GCA diagnosis. Outcomes: At a 6-week follow-up, the patient experienced complete resolution of bilateral sixth nerve palsies; however, there was no change in visual acuity of the left eye. Notably, the patient reported significant weight loss, leading to a malignancy screening, which confirmed pancreatic adenocarcinoma. Conclusion: This case focuses on the importance of early clinical suspicion and empiric glucocorticoid treatment for GCA, as well as maintaining vigilance for potential underlying malignancies in patients presenting with atypical symptoms.
Keyword: Giant Call arthritis; GCA; Abducens nerve palsy; Corticosteroid.
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