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Disease Profile

Sixth nerve palsy

Prevalence
Prevalence estimates on Rare Medical Network websites are calculated based on data available from numerous sources, including US and European government statistics, the NIH, Orphanet, and published epidemiologic studies. Rare disease population data is recognized to be highly variable, and based on a wide variety of source data and methodologies, so the prevalence data on this site should be assumed to be estimated and cannot be considered to be absolutely correct.

Unknown

Age of onset

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ICD-10

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Inheritance

Autosomal dominant A pathogenic variant in only one gene copy in each cell is sufficient to cause an autosomal dominant disease

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Autosomal recessive Pathogenic variants in both copies of each gene of the chromosome are needed to cause an autosomal recessive disease and observe the mutant phenotype

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X-linked
dominant X-linked dominant inheritance, sometimes referred to as X-linked dominance, is a mode of genetic inheritance by which a dominant gene is carried on the X chromosome.

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X-linked
recessive Pathogenic variants in both copies of a gene on the X chromosome cause an X-linked recessive disorder

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Mitochondrial or multigenic Mitochondrial genetic disorders can be caused by changes (mutations) in either the mitochondrial DNA or nuclear DNA that lead to dysfunction of the mitochondria and inadequate production of energy.

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Multigenic or multifactor Inheritance involving many factors, of which at least one is genetic but none is of overwhelming importance, as in the causation of a disease by multiple genetic and environmental factors.

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Not applicable

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Other names (AKA)

Cranial mononeuropathy VI; Abducens nerve palsy; Sixth cranial nerve palsy;

Summary

Sixth nerve palsy is a nerve disorder that occurs when the sixth cranial nerve is damaged. 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]

Symptoms

The signs and symptoms of sixth nerve palsy vary but may include:[3][4][5]

  • Double vision (particularly when looking to one side)
  • Headaches
  • Pain around the eye

Cause

Sixth nerve palsy has many potential causes, including:[1][3][4]

  • Stroke
  • Trauma
  • Viral illness
  • Brain tumors
  • Inflammation
  • Infections (such as meningitis)
  • Migraine headaches
  • Elevated pressure inside the brain
  • Gradenigo's syndrome (which also causes ear discharge and eye pain)
  • Multiple sclerosis
  • Pregnancy
  • Brain aneurysms
  • Small-vessel disease, particularly in diabetics (diabetic neuropathy)

The condition can be present at birth, but the most common cause in children is trauma. In some people, there is no clear cause.[1][3]

Diagnosis

A diagnosis of sixth nerve palsy is generally suspected based on the presence of characteristic signs and symptoms. Additional testing can then be ordered to confirm the diagnosis and determine the cause (if possible). This testing may include a thorough eye examination, blood tests, head imaging (such as a CT scan or MRI scan), and/or a spinal tap.[3][4]

Treatment

In some cases, sixth nerve palsy will disappear without treatment. If inflammation of the sixth nerve is suspected, medications called corticosteroids may be used. Until the nerve heals, wearing an eye patch can help with double vision. 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.[3][4][8]

Learn more

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Merck Manual for health care professionals provides information on Sixth nerve palsy.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Sixth nerve palsy. Click on the link to view a sample search on this topic.

References

  1. Sixth Nerve Palsy. AAPOS. August 2014; https://www.aapos.org/terms/conditions/98.
  2. Cranial Mononeuropathy VI. MedlinePlus. May 21, 2012; https://www.nlm.nih.gov/medlineplus/ency/article/000690.htm. Accessed 3/24/2014.
  3. Dugdale DC, Hoch DB. Cranial mononeuropathy VI. MedlinePlus. May 2014; https://www.nlm.nih.gov/medlineplus/ency/article/000690.htm.
  4. Michael P Ehrenhaus, MD. Abducens Nerve Palsy. Medscape Reference. February 2014; https://emedicine.medscape.com/article/1198383-overview.
  5. Andrew G Lee, MD; Paul W Brazis, MD. Sixth cranial nerve (abducens nerve) palsy in children. UpToDate. May 2015; Accessed 10/15/2015.
  6. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160079/.
  7. Carr MM, Ross DA, Zuker RM. Cranial nerve defects in congenital facial palsy. J Otolaryngol. April, 1997; 26(2):80-87. https://www.ncbi.nlm.nih.gov/pubmed/9106081.
  8. Sixth Nerve Palsy. American Association for Pediatric Ophthalmology and Strabismus. 2011; https://www.aapos.org/terms/conditions/98. Accessed 8/19/2011.

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