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6th_nerve_palsy [2026/07/14 18:43] – [References] Scott Larson6th_nerve_palsy [2026/07/14 18:48] (current) Scott Larson
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 ====== 6th Nerve Palsy ====== ====== 6th Nerve Palsy ======
- FIXME 
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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's canal, cavernous sinus, and orbit). 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).
  
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   * Cerebellopontine angle tumors   * Cerebellopontine angle tumors
   * Metastatic disease / leptomeningeal carcinomatosis   * 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) === === Raised Intracranial Pressure (False Localizing Sign) ===
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   * Neurosarcoidosis   * 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)   * 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   * 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](/rare-disease/thyroid-eye-disease) (restrictive myopathy)+  * 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](/rare-disease/guillain-barre-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 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   * 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/immune-mediated | | Most common cause | Microvascular ischemia (~37–46%) | Neoplasia and post-viral/immune-mediated |
 | 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://pubmed.ncbi.nlm.nih.gov/34991161|Kingma HJ, Ceulemans B. Recurrent Isolated Sixth Nerve Palsy in Children. Eur J Paediatr Neurol. 2022]]   - [[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}}