Differences

This shows you the differences between two versions of the page.

--- 6th_nerve_palsy [2026/07/14 18:42] – created Scott Larson
+++ 6th_nerve_palsy [2026/07/14 18:48] (current) – Scott Larson
@@ Line 1: / Line 1: @@
 ====== 6th Nerve Palsy ======
- FIXME
 The sixth cranial nerve has the longest intracranial course of any cranial nerve, making it vulnerable to a wide range of pathologies at multiple anatomical sites (brainstem, subarachnoid space, Dorello's canal, cavernous sinus, and orbit).
@@ Line 17: / Line 15: @@
   * Cerebellopontine angle tumors
   * Metastatic disease / leptomeningeal carcinomatosis
-  * [Nasopharyngeal carcinoma](/rare-disease/nasopharyngeal-carcinoma) with skull base invasion
+  * Nasopharyngeal carcinoma with skull base invasion
 === Raised Intracranial Pressure (False Localizing Sign) ===
@@ Line 37: / Line 35: @@
   * Neurosarcoidosis
-  * [Granulomatosis with polyangiitis](/rare-disease/granulomatosis-with-polyangiitis) (Wegener)
+  * Granulomatosis with polyangiitis (Wegener)
-  * [IgG4-related disease](/rare-disease/igg4-related-disease)
+  * IgG4-related disease
   * Tolosa-Hunt syndrome (painful ophthalmoplegia)
-  * [Giant cell arteritis](/rare-disease/giant-cell-arteritis)
+  * Giant cell arteritis
-  * [Systemic lupus erythematosus](/rare-disease/systemic-lupus-erythematosus)
+  * Systemic lupus erythematosus
-  * Sjögren syndrome
+  * [[sjogren_syndrome|Sjögren syndrome]]
   * Neuro-Behçet syndrome
@@ Line 72: / Line 70: @@
 === Neuromuscular Junction / Muscle ===
-  * Myasthenia gravis (may mimic CN VI palsy)
+  * [[ocular_myasthenia_gravis|Myasthenia gravis]] (may mimic CN VI palsy)
-  * [Thyroid eye disease](/rare-disease/thyroid-eye-disease) (restrictive myopathy)
+  * Thyroid eye disease (restrictive myopathy)
   * Miller Fisher syndrome (anti-GQ1b antibody)
@@ Line 96: / Line 94: @@
   * Brain tumors (secondary effect)
   * Hydrocephalus
-  * Idiopathic intracranial hypertension (pseudotumor cerebri)
+  * [[pediatric_iih|Idiopathic intracranial hypertension]] (pseudotumor cerebri)
   * Dural sinus thrombosis
 === Post-Infectious / Immune-Mediated ===
   * Anti-GQ1b syndrome (Miller Fisher spectrum)
-  * [Guillain-Barré syndrome](/rare-disease/guillain-barre-syndrome)
+  * Guillain-Barré syndrome
   * Post-viral (following upper respiratory infection or other viral illness)
-  * Post-vaccination</em>
+  * Post-vaccination
   * These account for ~50% of isolated cases in children
@@ Line 124: / Line 122: @@
 === Idiopathic ===
-  * Unordered List ItemNo identifiable cause in ~5–30% of pediatric cases
+  * No identifiable cause in ~5–30% of pediatric cases
   * Recurrent isolated sixth nerve palsy — rare; young females with left-sided palsy and recent immunization are at higher risk of recurrence. Complete recovery is typical
@@ Line 130: / Line 128: @@
 ^ Feature ^ Adults ^ Children ^
 | Most common cause | Microvascular ischemia (~37–46%) | Neoplasia and post-viral/immune-mediated |
 | Neoplasia prevalence | ~14% | ~20–25%; ~10% even in isolated palsies |
 | Microvascular ischemia | Very common | Very rare |
 | Post-viral / post-vaccination | Uncommon | Common (~50% of isolated cases) |
 | Spontaneous resolution | ~82% overall | ~59% overall; less likely with tumor etiology |
 | Neuroimaging recommendation | Based on clinical context | Recommended in all pediatric cases |
@@ Line 146: / Line 138: @@
   - [[https://pubmed.ncbi.nlm.nih.gov/35356946|Oh SY. Clinical Outcomes and Etiology of Acquired Sixth Cranial Nerve Palsy. Medicine (Baltimore). 2022]]
   - [[https://pubmed.ncbi.nlm.nih.gov/37154347|Kim HJ, Kim HJ, Choi JY, et al. Etiologic Distribution of Isolated Abducens Nerve Palsy: Analysis of 807 Patients and Literature Review. Eur J Neurol. 2023]]
   - [[https://pubmed.ncbi.nlm.nih.gov/34537871|Hörner S, et al. Sixth Cranial Nerve Palsy: Etiology and Outcome. J Neurol. 2022]]
   - [[https://doi.org/10.1212/WNL.0000000000004330|Meyer C, Wynn DP, Pulst SM, Chen R, Digre K. Clinical Reasoning: A 22-Year-Old Man With Diplopia. Neurology. 2017]]
   - [[https://doi.org/10.1212/01.wnl.0000284607.49249.24|Buracchio T, Rucker JC. Pearls and Oy-Sters of Localization in Ophthalmoparesis. Neurology. 2007]]
   - [[https://doi.org/10.1212/WNL.0000000000207543|Giacobbe A, et al. Clinical Reasoning: Sixth Nerve Palsy. Neurology. 2023]]
   - [[https://doi.org/10.1212/WNL.0000000000012093|Munro NA, Fernandez RL. Clinical Reasoning: Cranial Nerve Palsies. Neurology. 2018]]
   - [[https://pubmed.ncbi.nlm.nih.gov/34417775|Chang MY, Borchert MS. Etiology and Outcomes of Acquired Pediatric Sixth Nerve Palsies. J Neuroophthalmol. 2022]]
   - [[https://pubmed.ncbi.nlm.nih.gov/30760897|Park KA, Oh SY, Min JH, Kim BJ, Kim Y. Acquired Onset of Third, Fourth, and Sixth Cranial Nerve Palsies in Children and Adolescents. Eye (Lond). 2019]]
   - [[https://pubmed.ncbi.nlm.nih.gov/34879720|Hanna FA, Jabaly-Habib H, Halachmi-Eyal O, et al. Sixth Nerve Palsy in Children: Etiology, Long-Term Course, and a Diagnostic Algorithm. J Child Neurol. 2022]]
   - [[https://pubmed.ncbi.nlm.nih.gov/25806679|Teksam O, et al. Sixth Cranial Nerve Palsy in Children. J Pediatr Ophthalmol Strabismus. 2016]]
   - [[https://pubmed.ncbi.nlm.nih.gov/34991161|Kingma HJ, Ceulemans B. Recurrent Isolated Sixth Nerve Palsy in Children. Eur J Paediatr Neurol. 2022]]
-====Vertebrobasilar dolichoectasia and other arterial abnormalities====
+{{tag>strabismus ddx}}

strabismus ddx