Outcome of Sixth Nerve Palsy or Paresis in Young Children

Aroichane, Maryam; Repka, Michael X.

doi:10.3928/0191-3913-19950501-06

Cited by 52 publications

(18 citation statements)

References 7 publications

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“…The incidence of abducens nerve palsy increases with age and peaks in the 60s and 70s [4, 5], with the annual incidence at 4.7–11.3/100,000 [4, 5]. Various causes have been identified in abducens nerve palsy; the proportion of etiology has been different among studies depending on the classification of etiology, study population, and department where the patient recruitment was performed [4–29]. Furthermore, the etiology of abducens nerve palsy has been defined mainly in acquired forms in the previous institution‐ or population‐based studies, and few studies included congenital ones [4–8, 10–27, 29].…”

Section: Introductionmentioning

confidence: 99%

Etiologic distribution of isolated abducens nerve palsy: Analysis of 807 patients and literature review

Kim

Choi

et al. 2023

Euro J of Neurology

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Background and Purpose The etiologies of abducens nerve palsy have shown a large variability among studies. This study aimed to establish the clinical features and underlying etiologies of isolated abducens nerve palsy by recruiting patients from all departments in a referral‐based university hospital. Methods We reviewed the medical records of 807 patients with a confirmed diagnosis of isolated abducens nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, Republic of Korea, from 2003 to 2020. We also compared the proportion of etiology with that of the patients pooled from the previous studies. Results The most common etiology was microvascular (n = 296, 36.7%), followed by idiopathic (n = 143, 17.7%), neoplastic (n = 115, 14.3%), vascular anomalies (n = 82, 10.2%), inflammatory (n = 76, 9.4%), and traumatic (n = 35, 4.3%). Patients were mostly managed by ophthalmologists (n = 576, 71.4%), followed by neurologists (n = 479, 59.4%), emergency physicians (n = 278, 34.4%), neurosurgeons (n = 191, 23.7%), and others (n = 72, 8.9%). The proportion of etiology significantly differed according to the age and sex of the patients and the specialties involved in the management (p < 0.001). Compared to the pooled data from the previous reports, the current study showed a higher prevalence of microvascular cause but a lower occurrence of traumatic and neoplastic causes. Conclusions The results of previous studies on etiologic distribution of isolated abducens nerve palsy should be interpreted with consideration of the demographic features of patients recruited and the specialties involved.

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Section: Introductionmentioning

confidence: 99%

Etiologic distribution of isolated abducens nerve palsy: Analysis of 807 patients and literature review

Kim

Choi

et al. 2023

Euro J of Neurology

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“…Tumor was the most frequent etiology (37%), followed by nontumor increased intracranial pressure (ICP, 19%), trauma (13%), inflammation (9%), infection (8%), presumed postviral or postvaccination (6%), idiopathic (4%), and others (4%). Etiologies in the "other" category included nonneoplastic mass lesions (2 brainstem cavernomas and 1 fibrous dysplasia), anoxic brain injury (1), and vincristine toxicity (2).…”

Section: Resultsmentioning

confidence: 99%

“…In addition, unlike adults with CN6 palsies, children are at risk of strabismic amblyopia. Only 1 previous study has evaluated amblyopia in children with CN6 palsies, and the factors associated with risk for amblyopia in children with acquired CN6 palsies are unknown (2).…”

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confidence: 99%

“…Because of the relatively high frequency of tumors causing pediatric CN6 palsies, some authors recommend neuroimaging in all cases (1). However, others cite a low rate of malignancy in isolated cases (no other ophthalmologic or neurologic symptoms or signs) and suggest initial close follow-up in these patients, with neuroimaging if new symptoms or signs develop or spontaneous resolution does not occur (2,10). The risk of delayed diagnosis of a neoplasm or other serious neurologic disorders must be weighed against the risk of anesthesia to acquire neuroimaging in a young or uncooperative child.…”

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confidence: 99%

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Etiology and Outcomes of Acquired Pediatric Sixth Nerve Palsies

Chang

Borchert

2021

Journal of Neuro-Ophthalmology

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Background:Acquired sixth nerve (CN6) palsies in children may be benign or associated with an underlying neurologic condition. In children who presented with isolated (no associated neurologic or ophthalmic symptoms or signs) CN6 palsies, the rate of newly diagnosed neurologic disorders (such as tumors) is unclear. Moreover, the factors associated with spontaneous resolution and amblyopia in children with acquired CN6 palsies are unknown.Methods:We retrospectively reviewed the charts of all children younger than 18 years diagnosed with CN6 palsy at our institution from 2010 to 2020. We recorded ophthalmologic and neurologic history and examination findings, neuroimaging results, etiology of CN6 palsy, and outcomes including spontaneous resolution and amblyopia. We assessed etiologies of isolated and nonisolated CN6 palsies as well as frequency and factors associated with spontaneous resolution and amblyopia (in children ≤7 years).Results:One hundred seventy-two children met inclusion criteria. Twenty CN6 palsies (12%) were isolated at presentation. Most isolated cases were presumed postviral or postvaccination (50%) or idiopathic (30%), but 2 cases (10%) were associated with newly diagnosed tumors. Spontaneous resolution occurred in 59% of CN6 palsies at a median of 12.3 weeks and was associated with older age (P = 0.03) and nontumor etiology (P = 0.006). Amblyopia developed in 18% of children at risk, exclusively in those with anisometropia, pre-existing strabismus, or younger than 12 months.Conclusions:Our findings and chart reviews suggest that approximately 10% of isolated acquired pediatric CN6 palsies are associated with a newly diagnosed brain tumor. This risk must be discussed with parents when considering immediate vs delayed neuroimaging. In addition, infants and children ≤7 years with secondary amblyogenic risk factors (anisometropia or pre-existing strabismus) require close follow-up to monitor and treat amblyopia.

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“…Although recovery with Botulinum injection was comparable to spontaneous recovery in acute traumatic palsy, still it is important to decide on early intervention to restore fusion and hence prevent amblyopia. [ 16 17 ] No Botulinum injection was administered in the present study [ Table 3 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and management of sixth nerve palsy in pediatric patients (0–15 years) in Southern India – A hospital-based study

Kalita

Veena

Mouttappa³

et al. 2022

Indian Journal of Ophthalmology

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Purpose: This study was done to evaluate the clinical profile in pediatric patients (0–16 years) presenting with acute onset esotropia due to sixth nerve palsy and its management options in a tertiary care set up of Southern India. Methods: A total of 12 patients presenting to our OPD with acute onset esotropia due to sixth nerve palsies were included in this retrospective study. All patients were observed for 6 months and managed with prism and/or patching while waiting for spontaneous resolution and later managed surgically. Neuroimaging was done in all cases. Results: The mean deviation of esotropia at presentation was 30.17 ± 5.7 Prism Diopter (range 12–50 Prism Diopter 95% CI, SD 10.11). Mean age of the patients during presentation was 8.6 ± 2.4 years (range: 1–15 years, SD 4.27). Among the common causes of sixth nerve palsy in our study population were trauma and idiopathic intracranial hypertension followed by tumor and miscellaneous causes. Only three patients underwent surgical correction of residual deviation after a waiting period of 6 months for self-resolution. Spontaneous resolution was observed in 41.6% patients, and surgical correction (unilateral resection–recession) was done in 25% of the patients with good surgical outcome. Conclusion: At 1-year follow up, the motor outcome was satisfactory except for one patient who had diffuse pontine glioma and had worsening neurological symptoms on follow-up.

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Outcome of Sixth Nerve Palsy or Paresis in Young Children

Cited by 52 publications

References 7 publications

Etiologic distribution of isolated abducens nerve palsy: Analysis of 807 patients and literature review

Etiologic distribution of isolated abducens nerve palsy: Analysis of 807 patients and literature review

Etiology and Outcomes of Acquired Pediatric Sixth Nerve Palsies

Clinical profile and management of sixth nerve palsy in pediatric patients (0–15 years) in Southern India – A hospital-based study

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