Sixth nerve palsy

Sixth nerve palsy is the most frequent isolated ocular motor nerve palsy, and causes can range from self-limiting to life threatening. The management of these cases, including neuroimaging and further diagnostic testing, can be tailored according to the history, presentation, and clinical course. Specifically, the age of the patient; medical history including the presence of microvascular risk factors, known cancer (past or present), or recent trauma; timing of onset and progression of symptoms; and presence of other neurologic signs or symptoms should be considered when determining the need for neuroimaging. When neuroimaging is deemed appropriate, MRI of the brain and orbits with gadolinium should be performed, with inclusion of high-resolution skull base imaging for better visualization of the cranial nerves whenever possible. Further evaluation with serum and cerebrospinal fluid laboratory testing may be needed in some cases.