Abstract
Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. A 6-year-old girl presented with squinting and diplopia. Two weeks ago she suffered from mild cough and cold, likely viral fever. Cerebrospinal fluid analysis and magnetic resonance imaging of brain excluded any underlying disorder of central nervous system. Squint and diplopia subsided on its own within 3 weeks. Apart from serious etiologies benign isolated sixth nerve palsy can occur in children following viral prodrome and usually subsides within weeks without any treatment.
Highlights
Abducens/sixth cranial nerve, with its longest subarachnoid course from dorsal pons to lateral rectus muscle, is affected by tumour, trauma, hemorrhage, infections, demyelinating conditions, Miller Fisher syndrome, Gradenigo’s syndrome and rarely by ophthalmoplegic migraine [1]
We suggested the patching for right eye to prevent a double vision, and followed the patient by one-week interval
Knox et al in 1967 reported 12 children with a sixth nerve palsy as their chief presenting feature; 3 patients had otitis media complicated with Gradenigo syndrome, and for the other 9 patients the investigators assumed that the benign palsy was due to preceding viral febrile or upper respiratory illness
Summary
Abducens/sixth cranial nerve, with its longest subarachnoid course from dorsal pons to lateral rectus muscle, is affected by tumour, trauma, hemorrhage, infections, demyelinating conditions, Miller Fisher syndrome, Gradenigo’s syndrome and rarely by ophthalmoplegic migraine [1]. We present the case of a 6 years old girl with isolated right sided sixth nerve palsy resulting in squinting and diplopia. There was neither family history of any neurological disorders nor there was any contact history of tuberculosis On examination, she had obvious right-sided head position and she was continuously trying to close right eye to avoid diplopia. A non-contrast and contrast magnetic resonance imaging (MRI) scan of the head and neck confirmed normal brain and orbital structures. We thought of benign isolated sixth-nerve palsy in right eye. We suggested the patching for right eye to prevent a double vision, and followed the patient by one-week interval. At two weeks after the diagnosis, the double vision disappeared and lateral gaze palsy resolved partly. The patient is in follow up for last 1 year and didn’t relapse again
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