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Related Experiment Videos

Vertical misalignment in unilateral sixth nerve palsy.

Agnes M F Wong1, Douglas Tweed, James A Sharpe

  • 1Division of Neurology, University Health Network-Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8.

Ophthalmology
|July 3, 2002
PubMed
Summary

Vertical deviations in sixth nerve palsy are typically normal hyperphorias. Peripheral sixth nerve palsy causes head tilt-induced hyperdeviation, while central palsy results in consistent vertical strabismus with head tilt.

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Area of Science:

  • Ophthalmology
  • Neuro-ophthalmology
  • Neurology

Background:

  • Sixth nerve palsy, characterized by an abduction deficit, can be associated with vertical deviations.
  • Differentiating between peripheral and central causes of sixth nerve palsy is crucial for diagnosis and management.
  • The role of vertical deviations and their response to head tilt in sixth nerve palsy requires further elucidation.

Purpose of the Study:

  • To quantify vertical deviations in patients with unilateral sixth nerve palsy.
  • To compare vertical deviations in peripheral versus central sixth nerve palsy.
  • To assess the effect of static head tilt on vertical deviations in different types of sixth nerve palsy.

Main Methods:

  • A prospective, consecutive comparative case series design was employed.

Related Experiment Videos

  • Twenty patients with peripheral sixth nerve palsy, 7 with central palsy, and 10 normal subjects were evaluated.
  • Testing included prism and cover test, Maddox rod and prism test, and magnetic search coil recordings in various gaze positions and during static head tilt.

    • Main Results:

    • Peripheral sixth nerve palsy did not demonstrate abnormal vertical deviations compared to normal subjects across different testing methods.
    • Central sixth nerve palsy also showed vertical deviations within normal ranges.
    • Static head tilt induced contralateral hyperdeviation in peripheral palsy, whereas central palsy resulted in ipsilateral vertical strabismus irrespective of tilt direction.

    Conclusions:

    • Small vertical deviations in sixth nerve palsy are likely normal hyperphorias.
    • Head tilt-induced hyperdeviation patterns can help differentiate peripheral from central sixth nerve palsy.
    • Vertical deviations exceeding 5 prism diopters may suggest additional skew deviation or multiple cranial nerve palsies.