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| 6th_nerve_palsy [2026/07/14 18:43] – [References] Scott Larson | 6th_nerve_palsy [2026/07/14 18:48] (current) – Scott Larson | ||
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| ====== 6th Nerve Palsy ====== | ====== 6th Nerve Palsy ====== | ||
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| 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' | 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' | ||
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| * Cerebellopontine angle tumors | * Cerebellopontine angle tumors | ||
| * Metastatic disease / leptomeningeal carcinomatosis | * Metastatic disease / leptomeningeal carcinomatosis | ||
| - | * [Nasopharyngeal carcinoma](/ | + | * Nasopharyngeal carcinoma with skull base invasion |
| === Raised Intracranial Pressure (False Localizing Sign) === | === Raised Intracranial Pressure (False Localizing Sign) === | ||
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| * Neurosarcoidosis | * Neurosarcoidosis | ||
| - | * [Granulomatosis with polyangiitis](/ | + | * Granulomatosis with polyangiitis (Wegener) |
| - | * [IgG4-related disease](/ | + | * IgG4-related disease |
| * Tolosa-Hunt syndrome (painful ophthalmoplegia) | * Tolosa-Hunt syndrome (painful ophthalmoplegia) | ||
| - | * [Giant cell arteritis](/ | + | * Giant cell arteritis |
| - | * [Systemic lupus erythematosus](/ | + | * Systemic lupus erythematosus |
| - | * Sjögren syndrome | + | * [[sjogren_syndrome|Sjögren syndrome]] |
| * Neuro-Behçet syndrome | * Neuro-Behçet syndrome | ||
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| === Neuromuscular Junction / Muscle === | === Neuromuscular Junction / Muscle === | ||
| - | * Myasthenia gravis (may mimic CN VI palsy) | + | * [[ocular_myasthenia_gravis|Myasthenia gravis]] (may mimic CN VI palsy) |
| - | * [Thyroid eye disease](/ | + | * Thyroid eye disease (restrictive myopathy) |
| * Miller Fisher syndrome (anti-GQ1b antibody) | * Miller Fisher syndrome (anti-GQ1b antibody) | ||
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| * Brain tumors (secondary effect) | * Brain tumors (secondary effect) | ||
| * Hydrocephalus | * Hydrocephalus | ||
| - | * Idiopathic intracranial hypertension (pseudotumor cerebri) | + | * [[pediatric_iih|Idiopathic intracranial hypertension]] (pseudotumor cerebri) |
| * Dural sinus thrombosis | * Dural sinus thrombosis | ||
| === Post-Infectious / Immune-Mediated === | === Post-Infectious / Immune-Mediated === | ||
| * Anti-GQ1b syndrome (Miller Fisher spectrum) | * Anti-GQ1b syndrome (Miller Fisher spectrum) | ||
| - | * [Guillain-Barré syndrome](/ | + | * Guillain-Barré syndrome |
| * Post-viral (following upper respiratory infection or other viral illness) | * Post-viral (following upper respiratory infection or other viral illness) | ||
| - | * Post-vaccination</em> | + | * Post-vaccination |
| * These account for ~50% of isolated cases in children | * These account for ~50% of isolated cases in children | ||
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| === Idiopathic === | === Idiopathic === | ||
| - | * Unordered List ItemNo | + | * 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 | * 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 | ||
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| ^ Feature ^ Adults ^ Children ^ | ^ Feature ^ Adults ^ Children ^ | ||
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| | Most common cause | Microvascular ischemia (~37–46%) | Neoplasia and post-viral/ | | Most common cause | Microvascular ischemia (~37–46%) | Neoplasia and post-viral/ | ||
| | Neoplasia prevalence | ~14% | ~20–25%; ~10% even in isolated palsies | | | Neoplasia prevalence | ~14% | ~20–25%; ~10% even in isolated palsies | | ||
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| - [[https:// | - [[https:// | ||
| - | ====Vertebrobasilar dolichoectasia and other arterial abnormalities==== | + | {{tag> |