Sixth Nerve Palsy and Melanie

Melanie will need more tests and is scheduled for more on Friday at 3 p.m. She may not have the answers to her problem right away but the nurologist she saw thought she may have something known as "Sixth Nerve Palsy." She did hit her head on the swing set while she was here. She didn't hit it hard enough to cause a bruise but it may have been just enough to cause the problem. 

I hade never heard of Sixth Nerve Palsy before. It is also referred to as Cranial Nerve Palsy or Abducens Nerve Palsy

If an eye fails to move properly in all directions of gaze, a nerve palsy may be present, especially if the condition presents spontaneously in adulthood. 

Sixth Cranial Nerve Palsy presents with horizontal double vision, that is, the two images are horizontally misaligned. The double vision resolves when one eye is closed. In adults, the cause is usually a vascular infarct (diminished blood flow) of the nerve secondary to underlying diabetes or high blood pressure. Head trauma may also result in sixth cranial nerve palsy. In children, the condition usually follows a viral syndrome, though more serious intracranial inflammatory conditions and tumors must be considered. The diagnosis is usually easily confirmed by an ophthalmologist after observation of the eye movements in all fields of gaze. The affected eye will be unable to abduct (turn outwards beyond the midline). 

In adults with diabetes or high blood pressure and the sixth nerve palsy is the only other abnormal finding, a CT scan is usually not necessary. If there are any other concomitant neurological findings, pain, or a history of cancer, however, a CT scan will usually be obtained. In children, a CT scan is usually obtained to rule-out intracranial pathology. 

The prognosis for a full recovery in adults with diabetes or high blood pressure is good. However, recovery usually takes 3 to 6 months. Adults may elect to patch the eye to avoid double vision. In many cases, however, a temporary prism applied to the glasses may help restore single vision. The prism power may need changing every few weeks as the condition improves. For both children and adults in whom the condition fails to resolve, strabismus surgery may be considered.