Paresis of cranial nerve VI (N. abducens) after thoracic dural perforation.

Epidural anesthesia is associated with the risk of unintended dural perforation and concomitant leakage of cerebrospinal fluid (CSF) from the subarachnoidal space. This may remain asymptomatic or trigger post-dural puncture headache (PDPH). Cerebral nerve lesions after attempted epidural anesthesia are very rare. Here we report a case of unilateral paresis of the cranial nerve VI (N. abducens) after attempted thoracic epidural anesthesia. Herein, diagnosis of N. abducens paresis was probably delayed because the optical symptoms, such as blurred and double vision, were attributed to optical hallucinations caused by a concomitant (S)-ketamine infusion. In all patients with optical symptoms such as blurred or double vision a paresis of the abducens nerve should be considered.