Isolated Abducens Nerve Palsy Following Spinal Anesthesia

A healthy 28-year-old lady, para 1, presented to the emergency department with persistent frontal headache, nausea, and vomiting following an cesarean section four days ago. She experienced difficulties six failed attempts of spinal anesthesia intrapartum before conversion general anesthesia. 25-gauge Whitacre needle was utilized for administering under a sitting position. The anesthetist noticed loss resistance upon insertion, but only negligible amount cerebrospinal fluid obtained removing stylet. patient underwent due fetal distress, she not in labor during Otherwise, lasted hour uneventful. No eclampsia or pre-eclampsia. diagnosed post-dural puncture her symptoms improved after receiving intravenous hydration, oral caffeine, non-steroidal anti-inflammatory drug (NSAIDs). However, on sixth day anesthesia, suddenly developed double vision. Examination showed bilateral visual acuity measured at 6/7.5. proptosis ptosis noted. relative afferent pupillary defect negative no anisocoria. Both eyes were orthophoria normal head posture. Extraocular muscles revealed right abduction restriction -1 complaining binocular horizontal diplopia gaze, consistent abducens nerve palsy. Systemic neurological findings normal, imaging results unremarkable. Diagnosis palsy made clinically. keen conservative management instead blood patch therapy. Hence, treated supportively via uni-ocular patching relieve diplopia. Spontaneous complete recovery observed three weeks. Cranial is rare complication reported being commonest involved. Although it always benign, case spontaneous Awareness this uncommon will avoid unnecessary distress investigative burden both doctor.