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Pregnancy and galactosaemia

On reviewing the literature, there were only five cases of abducens nerve palsy complicating pregnancy reported (the search engines were Medline, Pubmed and Embase). A case of abducens nerve palsy occurred after a febrile illness during pregnancy (Blade par et al. 1968). Two cases were associated with pre-eclampsia (Sternberg et al. 1980; Barry-Kinsella et al. 1994). One case was following spinal anaesthesia for caesarean section (Moster et al. 1984). A case reported by Fung and Chung (1999) had no apparent cause. The abducens nerve has a long course from its point of emergence from the pons to the lateral rectus muscle. Paralysis may occur due to a lesion of the nerve in its long course. Possible causes of isolated abducens nerve palsy include vasculopathy, tumours, multiple sclerosis, inflammation, trauma or lumbar puncture (Fung and Chung 1999). However, in a significant number of cases, no cause is found (Fung and Chung 1999). Although possible mechanisms for abducens nerve palsy during pregnancy have been postulated, including inflammation of the nerve, downward displacement of the nerve secondary to the cerebral oedema and vasospasm of the vessels to the nerve (Sternberg et al. 1980; Barry-Kinsella et al. 1994), the exact cause of abducens nerve palsy in pregnancy is still not known. It has been suggested that clinical monitoring is sufficient when hypertension is found and further investigations are unwarranted if the nerve palsy resolved (Moster et al. 1984). However, infarction of abducens nerve fascicle in a patient with hypertension as a cause of transient isolated sixth nerve palsy has been reported (Donaldson and Rosenberg 1988). Therefore, we suggest that although the natural course of abducens nerve palsy appears to be benign, computerised tomogram scan or magnetic resonance imaging of the brain are still necessary to determine whether there is any intracranial lesion which may affect the intra-partum management of the patient. The associated hypertension, if present, should be controlled and where there is no definite pathology identified, appropriate reassurance can be given.