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Sixth Nerve Palsy in Children Etiology, Long-Term Course, and a Diagnostic Algorithm
Firas Abu Hanna1, Haneen Jabaly-Habib2,3, Orly Halachmi-Eyal4,5
1Department of Pediatrics B, 61172Emek Medical Center, Afula, Israel.
Journal of Child Neurology
|December 9, 2021
Summary
Acute onset sixth cranial nerve palsy in children has varied causes. Increased intracranial pressure and anti-GQ1B syndrome were most common. Neuroimaging and selective lab tests aid diagnosis.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neuro-ophthalmology
Background:
- Acute onset strabismus in children raises concern for sixth cranial nerve palsy.
- The diagnostic approach for sixth nerve palsy remains debated.
- Identifying underlying etiologies is crucial for appropriate management.
Purpose of the Study:
- To determine common causes of sixth nerve palsy in pediatric patients.
- To propose a practical diagnostic algorithm for pediatric sixth nerve palsy.
Main Methods:
- Retrospective review of pediatric patient records (January 2014 - April 2020).
- Inclusion criteria: diagnoses including sixth nerve palsy, Guillain-Barré syndrome, and others (ICD-9).
- Data extraction: clinical presentation, history, diagnostic work-up (serology, CSF, neuroimaging).
Main Results:
- Seventeen pediatric patients with sixth nerve palsy were identified.
- Most frequent etiologies: increased intracranial hypertension and anti-GQ1B syndrome (3 patients each).
Conclusions:
- Etiologies of pediatric sixth nerve palsy are diverse.
- Recommend neuroimaging for all patients.
- Consider serum and cerebrospinal fluid testing in select cases.
- Combined neuroimaging and laboratory testing facilitate diagnosis.
