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. 2022 Jun 29;15(2):147-152.
doi: 10.4103/ojo.ojo_133_21. eCollection 2022 May-Aug.

Clinical profile and magnetic resonance imaging characteristics of Duane retraction syndrome

Unnikrishnan Suma  1 , Mohammed Ferzana  1 , Valiyaveetil Babitha  1 , Poothatta Jyothi  1
Affiliations

Clinical profile and magnetic resonance imaging characteristics of Duane retraction syndrome

Unnikrishnan Suma et al. Oman J Ophthalmol. .

Abstract

Purpose: To describe the clinical profile and magnetic resonance imaging findings of the brain in Duane retraction syndrome (DRS) and determine whether there is an association between clinical presentation and magnetic resonance imaging (MRI) brain characteristics.

Materials and methods: This was a cross-sectional study done at a tertiary care center in South India. We recruited and analyzed the clinical characteristics of 54 patients with DRS. MRI of the brain with fast imaging employing steady-state acquisition (FIESTA) was performed in 41 cases, and the cisternal segment of the sixth nerve was studied. Statistical analysis was done to determine any association between the radiological and clinical features.

Results: Type 1 DRS was predominant, followed by Type 3 DRS and Type 2 DRS. 9.3% of cases were bilateral and 11.1% were familial. Orthotropia was most common, followed by esotropia and exotropia. The MRI brain showed the absence of the cisternal part of the sixth nerve on the affected side in 82% of Type 1 and 75% of Type 3 unilateral DRS. Both the abducens nerves were visualized in 19.5% of the patients with unilateral DRS. There was no statistically significant association between MRI brain findings and the clinical features.

Conclusions: MRI brain with FIESTA shows absent or hypoplastic sixth nerve in most cases of Type 1 and Type 3 DRS. However, around 20% of DRS cases may show the presence of the cisternal part of the sixth nerve. Hence, clinicians must be cautious when ruling out DRS on the basis of MRI brain findings. Although aplasia of the sixth nerve is the most frequent MRI finding, it may not be the sole etiologic factor.

Keywords: Abducens nerve; Duane retraction syndrome; fast imaging employing steady-state acquisition; magnetic resonance imaging.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart showing the magnetic resonance imaging brain findings encountered in this study
Figure 2
Figure 2
Nine-gaze photograph of a patient with unilateral Type 1 Duane retraction syndrome. There is restriction of abduction in the left eye with narrowing and retraction of the globe and upshoot on adduction
Figure 3
Figure 3
Magnetic resonance imaging fast imaging employing steady-state acquisition axial view taken at the level of the pontomedullary junction. The linear dark structure on the right, which the arrow points to, is the right abducens nerve. The left abducens nerve could not be identified
See this image and copyright information in PMC

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