Case Report: Unilateral Sixth Cranial Nerve Palsy Associated With COVID-19 in a 2-year-old Child

Children have been described to show neurological symptoms in acute coronavirus disease 2019 (COVID-19) and multisystemic inflammatory syndrome in children (MIS-C). We present a 2-year-old boy's clinical course of unilateral acute sixth nerve palsy in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Onset of the palsy in the otherwise healthy boy occurred seven days after symptoms attributed to acute infection had subsided respectively 3 weeks after onset of respiratory symptoms. SARS-CoV-2 specific IgG was detected in serum as well as in cerebrospinal fluid. The patient showed a prolonged but self-limiting course with a full recovery after three and a half months. This case illustrates in a detailed chronological sequence that sixth cranial nerve involvement may occur as post-infectious, self-limiting complication of pediatric SARS-CoV-2-infection thus expanding the neurological spectrum of symptoms for children with COVID-19. Clinicians should be aware of the possibility of post-infectious sixth nerve palsy related to SARS-CoV-2-infection particularly in view of recent respiratory tract infection or confirmed cases of SARS-CoV-2-infection amongst the patient's close contacts.

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Sixth nerve schwannomas

Journal of Neurosurgery ◽

10.3171/jns.1991.75.4.0638 ◽

1991 ◽

Vol 75 (4) ◽

pp. 638-641 ◽

Cited By ~ 30

Author(s):

Howard Tung ◽

Thomas Chen ◽

Martin H. Weiss

Keyword(s):

Cavernous Sinus ◽

Cranial Nerve ◽

Nerve Palsy ◽

Obstructive Hydrocephalus ◽

Surgical Excision ◽

Type I ◽

Sixth Cranial Nerve ◽

Content Type ◽

Sixth Nerve Palsy ◽

Sixth Nerve

✓ Two cases of sixth cranial nerve schwannoma are presented with a review of four other cases from the literature. The clinical spectrum, neuroradiological findings, and surgical outcome of the six cases are discussed. There are two distinct clinical presentations for sixth cranial nerve schwannomas. Type I sixth nerve schwannomas present with sixth nerve palsy and diplopia and arise from the cavernous sinus. In contrast, type II sixth nerve schwannomas have a more severe presentation with obstructive hydrocephalus, raised intracranial pressure, sixth nerve palsy, and diplopia. This type arises along the course of the sixth cranial nerve in the prepontine area. Cavernous sinus involvement in either type may preclude total surgical excision and indicate an increased possibility for recurrence.

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Sixth cranial nerve palsy secondary to compression by dolichoectatic vertebrobasilar artery

BMJ Case Reports ◽

10.1136/bcr-2020-234949 ◽

2020 ◽

Vol 13 (7) ◽

pp. e234949

Author(s):

Trishal Jeeva-Patel ◽

Edward A Margolin ◽

Daniel Mandell

Keyword(s):

Cranial Nerve ◽

Nerve Palsy ◽

High Spatial Resolution ◽

Cranial Nerves ◽

Three Dimensional ◽

Sixth Cranial Nerve ◽

Vertebrobasilar Artery ◽

Cranial Nerve Palsies ◽

Mri Sequences ◽

Sixth Nerve

Dolichoectasia refers to distinct elongation, dilatation and tortuosity of an artery. We present a rare well-illustrated case of dolichoectatic vertebrobasilar artery compressing the cisternal portion of the sixth cranial nerve resulting in chronic sixth nerve palsy. High spatial resolution, three-dimensional, heavily T2-weighted MRI sequences are uniquely positioned to assess the cranial nerves especially in their cisternal and canalicular portions and need to be performed for all patients with non-resolving cranial nerve palsies. Dolichoectatic vessels can be the cause of neurovascular conflict and cause non-resolving oculomotor palsies.

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A Study on the intraocular pressure of the affected and unaffected eyes in patients with isolated cranial nerve palsies

Acta Medica ◽

10.32552/0.actamedica.422 ◽

2020 ◽

Vol 51 (1) ◽

pp. 15-20

Author(s):

Özlem Dikmetaş ◽

Bogomil Voykov

Keyword(s):

Intraocular Pressure ◽

Cranial Nerve ◽

Nerve Palsy ◽

Sixth Nerve Palsy ◽

Tertiary Centre ◽

Cranial Nerve Palsies ◽

Significant Difference ◽

History Of ◽

The Mean ◽

Sixth Nerve

Objective: The role of elevated intraocular pressure (IOP) in the incidence and progression of glaucoma is well known. However, the exact mechanisms of IOP regulation are still unclear. Central IOP control has been suggested, but the autonomic pathway through which it acts is not known. The aim of this study was to investigate if isolated cranial nerve (CN) palsies of the third, fourth and sixth nerves are associated with an IOP difference between the affected and the unaffected eyes. Materials and Methods: This was a retrospective study including patients diagnosed with a third, fourth and sixth nerve palsy at a single tertiary centre. We included only patients with an isolated unilateral palsy. Patients with a history of strabismus, orbital disease or neurosurgical cases were excluded. Results: The charts of 1712 patients were reviewed. Third, fourth and sixth nerve palsies were found in 469 patients, 314 patients and 929 patients, respectively. Of all patients, 190 (10.6%) were eligible for inclusion in the study. A third nerve, fourth nerve or sixth nerve palsy was present in 85 (44.7%), 65 (34.2%) and 40 (21.1%) patients, respectively. The mean IOP of the affected eyes and the unaffected eyes was not statistically significant different: 14.1 ± 3.1 mmHg vs. 14.6 ± 2.7 mmHg in the CN3 group (p=0.087); 13.6 ± 2.6 mmHg vs. 13.7 ± 2.3 mmHg in the CN4 group (p=0.69); and 14.3 ± 2.7 mmHg vs. 14.9 ± 3.3 mmHg in the CN6 group (p=0.089). There was no statistically significant difference between the mean IOP differences of the affected and unaffected eyes among the three groups (p=0.47). Conclusion: Our study demonstrated no difference in IOP between affected and unaffected eyes in patients with an isolated cranial nerve palsy. These findings are the first and important for ophthalmology practice.

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Sixth nerve palsy as the presenting sign of delayed melanoma recurrence

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.69 ◽

2021 ◽

pp. 1-8

Author(s):

Arshia Eshtiaghi ◽

Michael TB Nguyen ◽

Jonathan A. Micieli

Keyword(s):

Nerve Palsy ◽

Sixth Nerve Palsy ◽

Sixth Nerve

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Augmented superior rectus muscle transposition in management of defective ocular abduction

BMC Ophthalmology ◽

10.1186/s12886-020-01779-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohamed F. Farid ◽

Ahmed E. M. Daifalla ◽

Mohamed A. Awwad

Keyword(s):

Nerve Palsy ◽

Rectus Muscle ◽

Muscle Transposition ◽

Primary Position ◽

Superior Rectus ◽

Sixth Nerve Palsy ◽

Abnormal Head ◽

Duane Retraction Syndrome ◽

Sixth Nerve ◽

Superior Rectus Muscle

Abstract Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

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