Isolated Sixth Nerve Palsy as the First Manifestation of Cavernous Sinus Metastasis From Primary Breast Cancer

✓ 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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Cavernous sinus subarachnoid diverticulum and sixth nerve palsy

Neuroradiology ◽

10.1007/bf00451776 ◽

1987 ◽

Vol 29 (3) ◽

pp. 306-307 ◽

Cited By ~ 4

Author(s):

Tatsuya Kobayashi ◽

Makoto Negoro ◽

Shinobu Awaya

Keyword(s):

Cavernous Sinus ◽

Nerve Palsy ◽

Sixth Nerve Palsy ◽

Sixth Nerve

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Nasopharyngeal carcinoma presenting as a sixth nerve palsy and Horner’s syndrome

BMJ Case Reports ◽

10.1136/bcr-2019-232291 ◽

2019 ◽

Vol 12 (10) ◽

pp. e232291 ◽

Cited By ~ 1

Author(s):

Hatim Batawi ◽

Jonathan A Micieli

Keyword(s):

Cavernous Sinus ◽

Nerve Palsy ◽

Disease Process ◽

Endoscopic Biopsy ◽

Horner’S Syndrome ◽

Horner's Syndrome ◽

Tissue Mass ◽

Barr Virus ◽

Sixth Nerve Palsy ◽

Sixth Nerve

The combination of a sixth nerve palsy and ipsilateral Horner’s syndrome localises the disease process to the posterior cavernous sinus and can be a result of various pathologies in this region. A 74-year-old Chinese woman presented with a 9-month history of binocular horizontal diplopia worse when looking left. She was found to have a left sixth nerve palsy and Horner’s syndrome and MRI revealed an enhancing soft tissue mass in the nasopharynx with involvement of the bones of the skull base and invasion of the left cavernous sinus. Endoscopic biopsy of the mass confirmed the diagnosis of non-keratinising squamous cell carcinoma, which was Epstein-Barr virus positive. She was treated with radiation therapy. Patients with a sixth nerve palsy and ipsilateral Horner’s syndrome should have urgent neuroimaging with careful attention to the cavernous sinus since sympathetic fibres join the sixth nerve for a short distance in this location.

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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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