Sixth nerve palsies in children

The causes of sixth nerve palsies in 75 children, all of whom had undergone modern neuroimaging, were reviewed. Neoplasms or their neurosurgical removal was the most common cause (n = 34 [45%]); elevated intracranial pressure (nontumor) (15%), traumatic (12%), congenital (11%), inflammatory (7%), miscellaneous (5%), and idiopathic (5%) causes represented other categories but were less commonly present. Isolated sixth nerve palsies were relatively uncommon (9%). On the basis of the relatively high risk of neoplasm, the authors suggest neuroimaging early in the clinical course of children with sixth nerve palsies, even if the palsy is isolated.