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Case Reports
. 2017 Feb 15:8:48.
doi: 10.3389/fneur.2017.00048. eCollection 2017.

Sixth Nerve Palsy from Cholesterol Granuloma of the Petrous Apex

Ségolène Roemer  1 , Philippe Maeder  2 , Roy Thomas Daniel  3 , Aki Kawasaki  1
Affiliations
Case Reports

Sixth Nerve Palsy from Cholesterol Granuloma of the Petrous Apex

Ségolène Roemer et al. Front Neurol. .

Abstract

Herein, we report a patient who had an isolated sixth nerve palsy due to a petrous apex cholesterol granuloma. The sixth nerve palsy appeared acutely and then spontaneously resolved over several months, initially suggesting a microvascular origin of the palsy. Subsequent recurrences of the palsy indicated a different pathophysiologic etiology and MRI revealed the lesion at the petrous apex. Surgical resection improved the compressive effect of the lesion at Dorello's canal and clinical improvement was observed. A relapsing-remitting sixth nerve palsy is an unusual presentation of this rare lesion.

Keywords: abducens palsy; cholesterol granuloma; diplopia; esotropia; petrous apex tumor; sixth nerve palsy; skull-base tumor.

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Figures

Figure 1
Figure 1
Lesion (white solid arrows) of the right petrous apex as viewed on different axial MRI sequences. (A) T2-weighted imaging shows a slightly heterogeneous lesion with parts isointense to white or gray matter. The dotted arrow shows the internal carotid artery. (B) The lesion is slightly hypointense to brain on T1 VIBE image and demonstrates slight peripheral enhancement following injection of gadolinium contrast. (C) The lesion is hypointense on diffusion trace image.
Figure 2
Figure 2
Close-up view (A) sagittal and (B) axial of the region of Dorello’s canal. The lesion is seen to enter Dorello’s canal (white arrows) and compress the right sixth nerve.
Figure 3
Figure 3
Axial view of head CTs taken in (A) 2011, (B) 2015, and (C) 2016. A small lesion (arrow) causing mild bony abnormality of right petrous apex is visible on 2011. Both petrous apices are highly pneumatized. The lesion progressively erodes the right petrous apex over 5 years.
Figure 4
Figure 4
Postoperative MRI images. (A) T2-weighted axial and (B) T1-weighted axial images after injection of gadolinium (B) show a notable regression of the right petrous apex lesion (white arrows). The content of the lesion is still heterogeneous. There is slight peripheral enhancement.
See this image and copyright information in PMC

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References

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