Concomitant sixth nerve and seventh nerve palsies

A previously healthy 24-year-old woman presented with binocular horizontal diplopia. Two weeks later she developed a right facial palsy without ageusia or hyperacusis. Examination revealed limited abduction OD with a 4 prism diopters of esotropia in primary gaze, increasing to 12 prism diopters in right gaze. These clinical findings are consistent with a right abducens palsy and a partial lower motor neuron palsy of the right facial nerve. MRI revealed an enhancing focus of increased …