Benign recurrent sixth nerve palsies in childhood. Secondary to immunization or viral illness

Four children had benign, isolated, and recurrent sixth nerve palsies. Two of the children had palsies that occurred following immunizations. This had not been previously reported, to our knowledge. The other two patients had palsies that followed mild, febrile illnesses that were assumed to be of viral origin. In all patients the palsy resolved without other associated neurologic signs or symptoms. When a child has an atraumatic sixth nerve palsy, a tumor, hydrocephalus, and meningitis must be considered. If the neurologic examination shows no associated abnormalities, invasive testing is not indicated. The patient should be followed up closely by the ophthalmologist and pediatrician for spontaneous recovery.