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Cranial mononeuropathy VI

Abducens paralysis; Abducens palsy; Lateral rectus palsy; VIth nerve palsy; Cranial nerve VI palsy; Sixth nerve palsy; Neuropathy - sixth nerve

 

Cranial mononeuropathy VI is a nerve disorder. It affects the function of the sixth cranial (skull) nerve. As a result, the person may have double vision.

Causes

 

Cranial mononeuropathy VI is damage to the sixth cranial nerve. This nerve is also called the abducens nerve. It helps you move your eye sideways toward your temple.

Disorders of this nerve can occur with:

  • Brain aneurysms
  • Nerve damage from diabetes(diabetic neuropathy)
  • Gradenigo syndrome (which also causes discharge from the ear and eye pain)
  • Tolosa-Hunt syndrome, inflammation of the area behind the eye
  • Increased or decreased pressure in the skull
  • Infections (such as meningitis or sinusitis)
  • Multiple sclerosis (MS), a disease that affects the brain and spinal cord
  • Pregnancy
  • Stroke
  • Trauma (caused by head injury or accidentally during surgery)
  • Tumors around or behind the eye

In some people, there is no clear cause.

Because there are common nerve pathways through the skull, the same disorder that damages the sixth cranial nerve may affect other cranial nerves (such as the third or fourth cranial nerve).

 

Symptoms

 

When the sixth cranial nerve doesn't work properly, you can't turn your eye outward toward your ear. You can still move your eye up, down, and toward the nose, unless other nerves are affected.

Symptoms may include:

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

 

Exams and Tests

 

Tests often show that one eye has trouble looking to the side while the other eye moves normally. An examination shows the eyes do not line up either at rest or when looking in the direction of the weak eye.

Your health care provider will do a complete examination to determine the possible effect on other parts of the nervous system. Depending on the suspected cause, you may need:

  • Blood tests
  • Head imaging study (such as an MRI or CT scan)
  • Spinal tap (lumbar puncture)

You may need to be referred to a doctor who specializes in vision problems related to the nervous system (neuro-ophthalmologist).

 

Treatment

 

If your provider diagnoses swelling or inflammation of, or around the nerve, medicines called corticosteroids may be used.

Sometimes, the condition disappears without treatment. If you have diabetes, you'll be advised to keep tight control of your blood sugar level.

The provider may prescribe an eye patch to relieve the double vision. The patch can be removed after the nerve heals.

 

Outlook (Prognosis)

 

Treating the cause may improve the condition. Even when no cause is found, recovery is usually complete.

 

Possible Complications

 

Complications may include permanent vision changes.

 

When to Contact a Medical Professional

 

Call your provider if you have double vision.

 

Prevention

 

There is no way to prevent this condition. People with diabetes may reduce the risk by controlling their blood sugar.

 

 

References

Azarmina M, Azarmina H. The six syndromes of the sixth cranial nerve. J Ophthalmic Vis Res. 2013;8(2):160-171. PMCID: PMC3740468 www.ncbi.nlm.nih.gov/pmc/articles/PMC3740468.

Rucker JC, Thurtell MJ. Cranial neuropathies. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 104.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

    Tests for Cranial mononeuropathy VI

     

       

      Review Date: 5/30/2016

      Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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