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Sixth Nerve Palsy in Paediatric Intracranial Hypertension
Julia E Reid1, Rachel E Reem2, Shawn C Aylward3
1Department of Ophthalmology, The Ohio State University , Columbus, Ohio, USA.
Insights
Sixth cranial nerve (CN VI) palsy occurs in about 12% of pediatric patients with intracranial hypertension (IH). Most cases presented with papilledema and resolved with treatment for IH.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neuroscience
Background:
- Intracranial hypertension (IH) is a condition affecting children, with varying causes including idiopathic (IIH) and secondary (SIH) forms.
- Sixth cranial nerve (CN VI) palsy, affecting eye movement, is a potential complication of neurological conditions.
Purpose of the Study:
- To determine the incidence and characteristics of sixth cranial nerve (CN VI) palsy in pediatric patients diagnosed with intracranial hypertension (IH).
Main Methods:
- A retrospective chart review was conducted for pediatric patients diagnosed with IH between 2010 and 2013.
- Data collected included patient demographics, medical history, IH etiology, ophthalmic findings, and treatment outcomes for patients with CN VI palsy.
Main Results:
- Of 78 pediatric IH patients, 9 (11.5%) had CN VI palsy (unilateral in 2, bilateral in 7).
- The mean opening pressure was 40 cm H2O, with 89% presenting papilledema.
- Causes of SIH included cerebral venous sinus thrombosis and infection; five patients had IIH.
Conclusions:
- The incidence of CN VI palsy in pediatric IH patients is approximately 12%.
- CN VI palsy in this population often presents with papilledema.
- All identified cases of CN VI palsy resolved following treatment of the underlying intracranial hypertension.
Abstract:
The purpose of this study was to report the incidence and describe the characteristics of sixth cranial nerve (CN VI) palsy in paediatric patients with intracranial hypertension (IH). A retrospective chart review of central Ohio children diagnosed with IH over the 3-year period from 2010 to 2013 was conducted. IH without identifiable cause was defined as idiopathic intracranial hypertension (IIH), whereas IH with identifiable pathologic aetiology was deemed secondary intracranial hypertension (SIH). A subset of patients with CN VI palsy was identified. Data collected included patient age, gender, past medical history, aetiology of SIH, ophthalmic examination, lumbar puncture results, neuroimaging results, and response to treatment. Seventy-eight children with intracranial hypertension were included in the study. Nine (11.5%) children (four males, five females; median age 14, range: 3-18) were found to have a unilateral (n = 2) or bilateral (n = 7) CN VI palsy. Five children had IIH; the remaining four had SIH from cerebral venous sinus thrombosis (n = 2) and infection (n = 2). The mean lumbar puncture opening pressure for the nine patients with CN VI palsy was 40 cm H2O (range: 21-65 cm H2O). Papilloedema was present in 8/9 (89%) patients. One patient required a lumboperitoneal shunt, and two others required optic nerve sheath fenestrations in addition to medical management. All cases of CN VI palsy resolved with treatment. In our primary service area, the incidence of CN VI palsy is approximately 12% among paediatric IH patients. The majority of cases with CN VI palsy presented with papilloedema and all cases resolved with treatment of intracranial hypertension.
