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Genetic and Rare Diseases Information Center (GARD)

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Sixth nerve palsy


Other Names for this Disease

  • 6th nerve palsy
  • Abducens nerve palsy
  • Cranial mononeuropathy VI
  • Cranial nerve VI palsy
  • Sixth cranial nerve palsy
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.

Overview

What is sixth nerve palsy?

What are the signs and symptoms of sixth nerve palsy?

What causes sixth nerve palsy?

Is sixth nerve palsy inherited?

How might sixth nerve palsy be treated?

What is the long term outlook for people with sixth nerve palsy?

What is sixth nerve palsy?

Sixth nerve palsy is a nerve disorder due to damage of the sixth cranial nerve. The disorder prevents some of the muscles that control eye movement from working properly. Affected people cannot turn the eye outwards toward the ear. Other signs and symptoms may include double vision, headaches, and pain around the eye. Sixth nerve palsy may be caused by many things, including stroke, brain aneurysm, diabetic neuropathy, trauma, infections, inflammation, tumors, migraine headaches or intracranial pressure. Eye patches, glasses, corticosteroids, and/or botulinum toxin may be used to ease symptoms. Some people may not need any treatment, while others may need surgery.[1][2]
Last updated: 3/24/2014

What are the signs and symptoms of sixth nerve palsy?

Symptoms may include double vision (particularly when looking to one side), headaches, and pain around the eye.[3]
Last updated: 8/19/2011

What causes sixth nerve palsy?

Sixth nerve palsy has many potential causes, the most common of which include stroke, trauma, viral illness, brain tumor, inflammation, infection (such as meningitis), migraine headache and elevated pressure inside the brain. The condition can be present at birth, but the most common cause in children is trauma. In older people, a small stroke is the most common cause. Sometimes, the cause is never found.[1]

Other causes of the condition can include:
  • small-vessel disease, particularly in diabetics (diabetic neuropathy)
  • tumors in the cavernous sinus, orbit, or base of the skull
  • Gradenigo's syndrome (which also causes ear discharge and eye pain)
  • meningeal carcinomatosis (spreading of cancer to the membranes around the brain and spinal cord)
  • Wernicke encephalopathy (a neurologic disorder)
  • brain aneurysm
  • vasculitis (inflammation of blood vessels)
  • multiple sclerosis
  • pregnancy

Determining the cause may require blood tests, MRI and/or lumbar puncture (spinal tap).[2][4]

Last updated: 3/25/2014

Is sixth nerve palsy inherited?

Sixth nerve palsy is not inherited and often results from any of a number of problems that cause damage to the sixth nerve. Many times, the cause remains unknown. The condition is usually acquired, but congenital sixth nerve palsy (present at birth) has been reported rarely. Congenital cases of isolated nerve palsy are possibly related to birth trauma, or nerve lesions in the temporal bone. Multiple congenital cranial nerve defects (more than one nerve affected) are more likely to be related to restricted blood flow (ischemia) in the prenatal period.[5][6]
Last updated: 3/25/2014

How might sixth nerve palsy be treated?

If inflammation of the sixth nerve is suspected, medications called corticosteroids may be used. Sometimes the condition will disappear without treatment. Until the nerve heals, wearing an eye patch can help with double vision.[3] Prism spectacles can also help to realign eyesight. After a period of observation, strabismus surgery may be considered. Botulinum toxin may also be used to temporarily weaken the inward pulling of the muscle.[7]
Last updated: 8/19/2011

What is the long term outlook for people with sixth nerve palsy?

The long term outlook (prognosis) depends on the underlying cause of the condition. Sixth nerve palsy caused by viral illness generally goes away completely while cases due to trauma may cause residual symptoms. The greatest improvement generally occurs in the first 6 months.[7] Most people with idiopathic sixth nerve palsy (of unknown cause) completely recover. Some people may experience permanent vision changes.[3]
Last updated: 8/19/2011

References
  1. Sixth Nerve Palsy. AAPOS. November, 2012; http://www.aapos.org/terms/conditions/98. Accessed 3/24/2014.
  2. Cranial Mononeuropathy VI. MedlinePlus. May 21, 2012; http://www.nlm.nih.gov/medlineplus/ency/article/000690.htm. Accessed 3/24/2014.
  3. Dugdale DC, Hoch DB. Cranial mononeuropathy VI. MedlinePlus. 2010; http://www.nlm.nih.gov/medlineplus/ency/article/000690.htm. Accessed 8/19/2011.
  4. Michael Rubin. Sixth Cranial Nerve Palsy. Merck Manuals. July, 2012; http://www.merckmanuals.com/professional/neurologic_disorders/neuro-ophthalmologic_and_cranial_nerve_disorders/sixth_cranial_nerve_palsy.html. Accessed 3/24/2014.
  5. Siddharth Agrawal, Vinita Singh, and Saurabh Agrawal. Congenital sixth nerve palsy or Type I Duane syndrome?. Oman J Ophthalmol. May-August, 2011; 4(2):92-94. Accessed 3/24/2014.
  6. Carr MM, Ross DA, Zuker RM. Cranial nerve defects in congenital facial palsy. J Otolaryngol. April, 1997; 26(2):80-87. Accessed 3/24/2014.
  7. Sixth Nerve Palsy. American Association for Pediatric Ophthalmology and Strabismus. 2011; http://www.aapos.org/terms/conditions/98. Accessed 8/19/2011.


Other Names for this Disease
  • 6th nerve palsy
  • Abducens nerve palsy
  • Cranial mononeuropathy VI
  • Cranial nerve VI palsy
  • Sixth cranial nerve palsy
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.