Abducens nerve palsy associated with dural puncture and neurovascular compression

Abstract

We present the case of a 59 years old man, who is diagnosed with a right sixth cranial nerve palsy, after the development of a dural post-puncture headache, secondary to an accidental dural puncture during an epidural. In magnetic resonance imaging, a compromise of the basilar artery space appears on the emergence of the right sixth cranial nerve. Possibly, this vascular anatomical variant, predisposed him to a greater vulnerability of the abducens nerve. The traction of the nerve could cause a neural ischemia, so intracranial hypotension could be the trigger of the palsy. He recovered completely with conservative treatment.