SHM Converge Scientific Abstract ePoster Gallery-Abducens Nerve Palsy as the Presenting Sign of Cryptococcal Meningitis

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This case highlights cryptococcal meningitis as an important cause of acute sixth cranial nerve (abducens) palsy, especially in patients with possible immunocompromise. A 54-year-old woman with hypertension and sickle cell anemia presented with 10 days of headache, blurry vision, confusion, and falls. Exam showed diplopia with medial deviation of the left eye, consistent with left abducens palsy, along with mild left leg weakness and conductive hearing loss. Initial CT brain and CT angiography were normal, but lumbar puncture revealed elevated opening pressure (32 cm H2O). CSF cryptococcal antigen and titers were positive, and HIV testing was also positive. The patient was later found to have untreated HIV since 2006.<br /><br />She was treated with amphotericin B and flucytosine, underwent serial lumbar punctures to reduce intracranial pressure, and improved clinically, including resolution of the abducens palsy. She was transitioned to fluconazole and started on antiretroviral therapy before discharge.<br /><br />The report emphasizes that sixth nerve palsy is often associated with mass lesions, trauma, or multiple sclerosis, but infection—particularly cryptococcal meningitis—should also be considered. In advanced HIV, isolated abducens palsy may be an early sign of cryptococcal meningitis or lymphoma. Because the palsy can result from elevated intracranial pressure or direct nerve involvement, acute sixth nerve palsy warrants lumbar puncture and evaluation for intracranial hypertension and infectious causes, including HIV.

Asset Subtitle

Subhan Tabba

Meta Tag

Author List Asif Kabani, Rahul Gill, Subhan Tabba, Tapan Patel

Category Clinical Vignettes

Concept Abducens Nerve Palsy

Concept Cryptococcal Meningitis

Concept Intracranial Pressure

Concept Lumbar Puncture

Concept Infectious Disease

Distinguished Non-Finalist

Presenter Organization Texas Health Presbyterian Hospital of Dallas

Presenting Author Subhan Tabba

Track Adult

Keywords

cryptococcal meningitis

abducens palsy

sixth cranial nerve palsy

HIV

intracranial hypertension

lumbar puncture

cryptococcal antigen

amphotericin B

flucytosine

antiretroviral therapy

Abducens Nerve Palsy

Cryptococcal Meningitis

Intracranial Pressure

Lumbar Puncture

Infectious Disease