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Kocer B, Ergan S et al. Quintessence Int 2009; 40: 251–256

Isolated abducens nerve palsy has been reported as an initial manifestation of multiple sclerosis (MS) in as high as of 12% (17% in Discussion) of those who develop the condition. It has also been stated that spinal anaesthesia may exacerbated MS. This paper describes a 30-year-old man who presented to a neurology department with sudden diplopia on lateral gaze, following an inferior dental nerve block with articaine for tooth extractions the day previously. According to specific diagnostic criteria, MS was diagnosed after magnetic resonance imaging of the cranium and biochemical tests. The authors cite others who have reported transient palsies of those cranial nerves that transverse the cavernous sinus following dental local anaesthesia by diffusion of local anaesthetic solution via the pterygoid venous plexus into this structure.