abducens nerve diseases


Summary: Diseases of the sixth cranial (abducens) nerve or its nucleus in the pons. The nerve may be injured along its course in the pons, intracranially as it travels along the base of the brain, in the cavernous sinus, or at the level of superior orbital fissure or orbit. Dysfunction of the nerve causes lateral rectus muscle weakness, resulting in horizontal diplopia that is maximal when the affected eye is abducted and ESOTROPIA. Common conditions associated with nerve injury include INTRACRANIAL HYPERTENSION; CRANIOCEREBRAL TRAUMA; ISCHEMIA; and INFRATENTORIAL NEOPLASMS.

Top Publications

  1. Goodwin D. Differential diagnosis and management of acquired sixth cranial nerve palsy. Optometry. 2006;77:534-9 pubmed
    ..If resolution does not occur within 2 to 3 months, the condition progresses, or if additional neurologic signs or symptoms develop, imaging studies are indicated. ..
  2. Laurens M, Becker R, Johnson J, Wolf J, Kotloff K. MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient. Int J Pediatr Otorhinolaryngol. 2008;72:945-51 pubmed publisher
    ..This case exemplifies an aggressive MRSA intracranial infection that advanced despite antibiotic therapy...
  3. Liao W, Chu G, Hutnik C. Herpes zoster ophthalmicus and sixth nerve palsy in a pediatric patient. Can J Ophthalmol. 2007;42:152-3 pubmed
  4. Tsuda H, Yorinaga Y, Tamada Y, Kutsuki S, Nakanoma T, Tai K, et al. Combination of abducens nerve palsy and ipsilateral postganglionic Horner syndrome as an initial manifestation of uterine cervical cancer. Intern Med. 2009;48:1457-60 pubmed
    ..Moreover, this is the first reported case of uterine cervical cancer with intra-cavernous sinus metastasis...
  5. Knapp C, Gottlob I. Benign recurrent abducens (6th) nerve palsy in two children. Strabismus. 2004;12:13-6 pubmed
    ..The diagnosis should be considered in any child who experiences abducens nerve palsy in the absence of any underlying pathology or precipitating factors. ..
  6. Jones C, Siva T, Seymour F, O Reilly B. Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy. J Laryngol Otol. 2006;120:502-4 pubmed
    ..We report a case of Lemierre's syndrome in an 18-year-old Caucasian woman presenting with a peritonsillar abscess and ipsilateral VIth cranial nerve palsy...
  7. Tsuda H, Ishikawa H, Asayama K, Saito T, Endo S, Mizutani T. Abducens nerve palsy and Horner syndrome due to metastatic tumor in the cavernous sinus. Intern Med. 2005;44:644-6 pubmed
    ..This is the first case of combination of abducens nerve palsy and ipsilateral Horner syndrome due to metastasis from parotid carcinoma to the cavernous sinus...
  8. Sturm V, Schöffler C. Long-term follow-up of children with benign abducens nerve palsy. Eye (Lond). 2010;24:74-8 pubmed publisher
    ..As none of the patients developed long-term recurrences or neurological sequelae, this entity can be regarded as a benign condition without malignant associations or complications. ..
  9. Shin M, Choi C, Lee M. A case of herpes zoster with abducens palsy. J Korean Med Sci. 2007;22:905-7 pubmed
    ..After 5 days of systemic antiviral therapy, the skin lesions improved markedly, and the paralysis was cleared 7 weeks later without extra treatment. ..

More Information


  1. Patel S, Mutyala S, Leske D, Hodge D, Holmes J. Incidence, associations, and evaluation of sixth nerve palsy using a population-based method. Ophthalmology. 2004;111:369-75 pubmed
  2. Khemka S, Mearza A. Isolated sixth nerve palsy secondary to spontaneous intracranial hypotension. Eur J Neurol. 2006;13:1264-5 pubmed
    ..Treatment was successful with epidural blood patching. The case is discussed and the relevant literature reviewed. ..
  3. Kurihara T. Abducens nerve palsy and ipsilateral incomplete Horner syndrome: a significant sign of locating the lesion in the posterior cavernous sinus. Intern Med. 2006;45:993-4 pubmed
  4. Jude E, Chakraborty A. Images in clinical medicine. Left sixth cranial nerve palsy with herpes zoster ophthalmicus. N Engl J Med. 2005;353:e14 pubmed
  5. Hirao M, Oku H, Sugasawa J, Utsumi T, Ikeda T. [Three cases of abducens nerve palsy accompanied by Horner syndrome]. Nippon Ganka Gakkai Zasshi. 2006;110:520-4 pubmed
    ..To report three cases of nasopharyngeal carcinoma, exhibiting abducens nerve palsy and Horner syndrome during the medical treatment of the tumor, whose invasive cavernous sinus lesions could be detected...
  6. Kishi M, Sakakibara R, Ogawa E, Tateno F, Takahashi O, Koga M. Bilateral abducens palsy in a case of cytomegalovirus-associated Guillain-Barré syndrome. Neurol Sci. 2011;32:1219-22 pubmed publisher
    ..Her neurological signs gradually recovered after high-dose intravenous administrations of immunoglobulin. CMV infection should be listed in the differential diagnosis of GBS patients who present with ophthalmoparesis. ..
  7. Tsuda H, Ishikawa H, Kishiro M, Koga N, Kashima Y. Abducens nerve palsy and postganglionic Horner syndrome with or without severe headache. Intern Med. 2006;45:851-5 pubmed
    ..To report the clinical features of 9 patients with both abducens nerve palsy and postganglionic Horner syndrome...
  8. Mahoney N, Liu G. Benign recurrent sixth (abducens) nerve palsies in children. Arch Dis Child. 2009;94:394-6 pubmed publisher
  9. Niedermüller U, Trinka E, Bauer G. Abducens palsy after lumbar puncture. Clin Neurol Neurosurg. 2002;104:61-3 pubmed
    ..The presented case emphasizes the use of atraumatic small-size needles for lumbar puncture. ..
  10. Pullicino P, Lincoff N, Truax B. Abnormal vergence with upper brainstem infarcts: pseudoabducens palsy. Neurology. 2000;55:352-8 pubmed
    ..Pseudoabducens palsy and CRN are probably both manifestations of abnormal vergence activity. Inhibitory descending pathways for convergence may pass through the thalamus and decussate in the subthalamic region. ..
  11. Ozveren M, Uchida K, Erol F, Tiftikci M, Cobanoglu B, Kawase T. Isolated abducens nerve paresis associated with incomplete Horner's syndrome caused by petrous apex fracture--case report and anatomical study. Neurol Med Chir (Tokyo). 2001;41:494-8 pubmed
    ..Concurrent functional loss of the abducens nerve and the periarterial sympathetic plexus clinically manifested as incomplete Horner's syndrome in our patient...
  12. Rangasami J, Puliyel J. Gradenigo's syndrome. Indian Pediatr. 2006;43:456-7 pubmed
  13. Salvin J, Repka M, Miller M. Arachnoid cyst resulting in sixth nerve palsy in a child. J Pediatr Ophthalmol Strabismus. 2007;44:53-4 pubmed
    ..Neurosurgical shunting followed by strabismus surgery relieved the abduction deficit and esotropia. An arachnoid cyst may be a rare cause of acquired sixth nerve palsy and strabismus in children. ..
  14. Dietrich H, Glasauer S, Straka H. Functional Organization of Vestibulo-Ocular Responses in Abducens Motoneurons. J Neurosci. 2017;37:4032-4045 pubmed publisher
    ..Accordingly, the physiological and pharmacological understanding of specific motoneuronal contributions to eye movements might help in designing drug therapies for human eye movement dysfunctions such as abducens nerve palsy. ..
  15. Nishida Y, Hayashi O, Oda S, Kakinoki M, Miyake T, Inoki Y, et al. A simple muscle transposition procedure for abducens palsy without tenotomy or splitting muscles. Jpn J Ophthalmol. 2005;49:179-80 pubmed
  16. Kalidindi R, Balen F, Hassan A, Al Din A. Persistent trigeminal artery presenting as intermittent isolated sixth nerve palsy. Clin Radiol. 2005;60:515-9 pubmed
  17. Nguyen T, Cho Y, Jang Y, Park M, Shin S. Long delayed traumatic carotid-cavernous sinus fistula. J Craniofac Surg. 2013;24:e237-9 pubmed publisher
    ..According to this case, we recommend a careful follow-up until 2 months for patients with skull base fracture in order to rule out the risk of CCF...
  18. Thamban S, Nama V, Sharma R, Kollipara P. Abducens nerve palsy complicating pregnancy. J Obstet Gynaecol. 2006;26:811-2 pubmed
  19. Johnston N, Choudhari K. Bilateral sixth nerve palsy: a rare presentation of postoperative posterior fossa extradural haematoma. Br J Neurosurg. 2003;17:272-3 pubmed
  20. Barraclough J, Pearman K, Solanki G. Extradural haematoma presenting as a contralateral sixth nerve palsy after cochlear implantation. Cochlear Implants Int. 2009;10:112-8 pubmed publisher
    ..The abducens palsy resolved after evacuation of the haematoma and the patient made an excellent recovery. The literature is reviewed and the mechanism of injury discussed. ..
  21. Kanazawa T, Iwasaki T, Takahashi M, Kakinuma K, Ezuka I, Yamada H. [Detailed magnetic resonance imaging of abducens nerve by 3D-CISS]. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2003;59:958-64 pubmed
    ..This reliable technique can be performed for the diagnosis of abducens nerve palsy. ..
  22. Yip W, Yu C, Fan D, Yick D, Rao S, Lam D. Anterior segment ischemia after two-muscle surgery in a patient with radiation-treated nasopharyngeal carcinoma. J Pediatr Ophthalmol Strabismus. 2008;45:40-2 pubmed
    ..The case was successfully treated with systemic steroids but with reduced best-corrected visual acuity. Previous radiotherapy in the related orbital field may be a new risk factor for this condition. ..
  23. Kim J, Hwang J. Presence of the abducens nerve according to the type of Duane's retraction syndrome. Ophthalmology. 2005;112:109-13 pubmed
    ..In terms of the presence or absence of the abducens nerve, type 1 and type 2 DRS were homogenous, and type 3 DRS was heterogenous. ..
  24. Schwyzer L, Tuleaşcă C, Borruat F, Radovanovic I, Levivier M. Gamma Knife surgery for a hemangioma of the cavernous sinus in an adult: Case report and short review of the literature. Neurochirurgie. 2017;63:320-322 pubmed publisher
    ..These clinical and radiological results persisted over the next 3 years. ..
  25. Herath H, Pahalagamage S, Withana D, Senanayake S. Complete ophthalmoplegia, complete ptosis and dilated pupil due to internal carotid artery dissection: as the first manifestation of Takayasu arteritis. BMC Cardiovasc Disord. 2017;17:201 pubmed publisher
    ..In cases of internal carotid artery dissection, vasculitis such as Takayasu arteritis should also be considered. ..
  26. Merino P, Fuentes D, Gómez de Liaño P, Ordóñez M. Binocular diplopia in a tertiary hospital: Aetiology, diagnosis and treatment. Arch Soc Esp Oftalmol. 2017;: pubmed publisher
    ..Structural lesions in imaging tests were more than expected. Only one third of patients had a spontaneous resolution, and half of them did not have a good outcome despite of treatment. ..
  27. Wright S, Shaikh Z, Castillo Lugo J, Tanriover B. Aseptic meningitis and abducens nerve palsy as a serious side effect of high dose intravenous immunoglobulin used in a patient with renal transplantation. Transpl Infect Dis. 2008;10:294-7 pubmed
    ..Potential mechanisms of the IGIV-related aseptic meningitis are elaborated. Clinicians should be aware of aseptic meningitis and cranial nerve palsy as an adverse reaction to IGIV exposure and monitor for its signs and symptoms. ..
  28. Ayberk G, Ozveren M, Yildirim T, Ercan K, Cay E, Koçak A. Review of a series with abducens nerve palsy. Turk Neurosurg. 2008;18:366-73 pubmed
    ..A botilinum injection was performed in three patients with the abducens palsy. Botilinum injection can help patients with sixth nerve palsy during the recovery period. ..
  29. Verret D, Samy R. Bilateral cholesterol granulomas. Otol Neurotol. 2005;26:1041-4 pubmed
  30. Kato H, Nakajima M, Ohnaka Y, Ishihara K, Kawamura M. Recurrent abducens nerve palsy associated with neurovascular compression. J Neurol Sci. 2010;295:135-6 pubmed publisher
    ..Together with a lack of the preceding headache or febrile illness, we propose that neurovascular compression is a possible etiology of recurrent, isolated abducens nerve palsy. ..
  31. Cassereau J, Letournel F, Francois S, Dubas F, Nicolas G. Chronic inflammatory demyelinating polyneuropathy in Waldenström's macroglobulinemia. Rev Neurol (Paris). 2011;167:343-7 pubmed publisher
    ..In patients with WD, the possible occurrence of CIDP should be investigated with a neuromuscular biopsy when other investigations are equivocal since the disease calls for a specific treatment. ..
  32. Abdul Hussein A, Morris P, Markova T. An unusual presentation of adenoid cystic carcinoma of the minor salivary glands with cranial nerve palsy: a case study. BMC Cancer. 2007;7:157 pubmed
    ..Our unique case demonstrates direct invasion of cavernous sinus and could explain the 5th and 6th cranial nerve involvement as histopathology revealed no perineural invasion. ..
  33. Zimmermann Paiz M, Fang Sung J. [Sixth nerve palsies in children. Presentation of four cases]. Arch Argent Pediatr. 2008;106:449-53 pubmed publisher
    ..Due to the importance of the adequate management and possible implications of this pathology, four patients are presented for analysis and discussion. ..
  34. Catala Antunez I, de Quintana Schmidt C, Clavel Laria P, Montes Graciano G, Molet Teixido J. [Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and literature review]. Neurocirugia (Astur). 2011;22:337-41 pubmed
    ..Traumatic retroclival hematomas are mainly a pediatric entity due to immaturity of the cranio-cervical junction. Treatment consists of placement of a rigid collar although clinical progression may require surgical evacuation. ..
  35. Brinar V, Habek M, Ozretic D, Djakovic V, Matijević V. Isolated nontraumatic abducens nerve palsy. Acta Neurol Belg. 2007;107:126-30 pubmed
    ..If this finding remains inconclusive, additional tests including angiography and CSF examination should be performed. ..
  36. Sun H, Sharma K, Kalakoti P, Thakur J, Patra D, Konar S, et al. Factors Associated with Abducens Nerve Recovery in Patients Undergoing Surgical Resection of Sixth Nerve Schwannoma: A Systematic Review and Case Illustration. World Neurosurg. 2017;104:883-899 pubmed publisher
    ..CS involvement is associated with lesser odds for functional nerve recovery in patients undergoing surgical resection for CN VI schwannoma. ..
  37. Kau H, Tsai C. Abducens ocular neuromyotonia in a patient with nasopharyngeal carcinoma following concurrent chemoradiotherapy. J Neuroophthalmol. 2010;30:266-7 pubmed publisher
    ..While diplopic complaints in patients with NPC raise suspicion of tumor recurrence or radiation-related cranial neuropathy, ONM must also be kept in the differential diagnosis. ..
  38. Saleh Z, Menassa J, Abbas O, Atweh S, Arayssi T. Cranial nerve VI palsy as a rare initial presentation of systemic lupus erythematosus: case report and review of the literature. Lupus. 2010;19:201-5 pubmed publisher
    ..Within 2 weeks of steroid initiation, complete recovery occurred. The unusual rare presentation of SLE in the current patient, as well as the pathogenesis and treatment of cranial neuropathy in SLE are discussed. ..
  39. Thomas A, Shetty A, Rajasekaran S. Abducens nerve palsy associated with pseudomeningocele after lumbar disc surgery: a case report. Spine (Phila Pa 1976). 2012;37:E511-3 pubmed publisher
    ..After confirmation of pseudomeningocele radiologically, early surgical intervention with repair of the dural defect can result in complete recovery of the abducens nerve palsy. ..
  40. Kim J, Hwang J. Abducens nerve is present in patients with type 2 Duane's retraction syndrome. Ophthalmology. 2012;119:403-6 pubmed publisher
    ..Magnetic resonance imaging revealed the presence of the abducens nerve in all the affected eyes (n = 13) of 12 patients with type 2 DRS. The abducens nerve is present on the affected side in type 2 Duane's retraction syndrome. ..
  41. Jensen P, Hansen M, Møller M, Saunte J. The Forgotten Syndrome? Four Cases of Gradenigo's Syndrome and a Review of the Literature. Strabismus. 2016;24:21-7 pubmed publisher
    ..GS is a rare and potentially life-threatening complication to otitis media. GS can present in an acute and chronic form, and should be a differential diagnosis in the workup of unexplained sixth nerve palsy. ..
  42. Snir M, Friling R, Kalish Stiebel H, Sherf I, Weinberger D, Axer Siegel R. Full vertical rectus muscle transposition combined with medial posterior fixation sutures for patients with adduction deficiency. Ophthalmology. 2005;112:939-43 pubmed
    ..The augmented full vertical rectus muscle procedure is a beneficial surgical approach for patients with ADD and Duane's retraction syndrome type 2, reducing the need for multiple extraocular muscle surgery. ..
  43. Pandey P, Garg D, Bhatia A, Jain V. Horner's syndrome and sixth nerve palsy due to herpes zoster ophthalmicus arteritis. Eye (Lond). 2005;19:224-6 pubmed
  44. Yilmaz M, Ozaras R, Mert A, Ozturk R, Tabak F. Abducent nerve palsy during treatment of brucellosis. Clin Neurol Neurosurg. 2003;105:218-20 pubmed
  45. Dursun I, Gunduz Z, Poyrazoglu H, Gumus H, Yikilmaz A, Dusunsel R. Cerebral vasculitis and unilateral sixth-nerve palsy in acute post-streptococcal glomerulonephritis. Ann Trop Paediatr. 2008;28:155-9 pubmed publisher
    ..All clinical and laboratory abnormalities improved with corticosteroid therapy, pulse methyl-prednisolone. APSGN can present with central nervous system abnormalities without hypertension, uraemia and electrolyte disturbance. ..
  46. Warwar R, Bhullar S, Pelstring R, Fadell R. Sudden death from pituitary apoplexy in a patient presenting with an isolated sixth cranial nerve palsy. J Neuroophthalmol. 2006;26:95-7 pubmed
    ..Pituitary apoplexy should be considered a cause of acute isolated sixth cranial nerve palsy and may represent a life-threatening emergency that can be averted with emergent hormonal replacement and hypophysectomy. ..
  47. Furtado S, Mohan D, Hegde A. Ophthalmic segment aneurysmal subarachnoid hemorrhage presenting with contralateral abducens nerve palsy: a false localizing sign. Optometry. 2010;81:450-3 pubmed publisher
    ..Abducens weakness in the above-50 age group is most commonly caused by a vascular etiology. The authors discuss the pathogenesis of this rare clinical entity and present pertinent literature review. ..
  48. Gkrania Klotsas E, Cooke F, Zochios V, Lofitou N. Fever, a blue hand, and abducens nerve paralysis in a returning traveler. J Travel Med. 2009;16:57-9 pubmed publisher
    ..We present an extraordinary case of typhoid fever, manifesting as hand cyanosis as well as abducens nerve paresis, all of which promptly resolved with antibiotics. ..
  49. Ada M, Kaytaz A, Tuskan K, Güvenç M, Selcuk H. Isolated sphenoid sinusitis presenting with unilateral VIth nerve palsy. Int J Pediatr Otorhinolaryngol. 2004;68:507-10 pubmed
    ..We discuss the clinical features, the diagnostic tools, and the treatment options for this entity...
  50. Na J, Park S, Shin S. Multiple myeloma manifesting as a fluctuating sixth nerve palsy. Korean J Ophthalmol. 2009;23:232-3 pubmed publisher
    ..Multiple myeloma may be included in the differential diagnosis of a fluctuating sixth nerve palsy, and although ophthalmic signs are rare and generally occur late in the course of multiple myeloma, they can still be its first signs. ..
  51. Li X, Wei S, Song E, Zhou H. [Clinical analysis of internal carotid artery aneurysm accompanied with ocular manifestations]. Zhonghua Yan Ke Za Zhi. 2010;46:1075-8 pubmed
    ..Ocular changes in AICA include decrease of visual acuity, oculomotor palsy, abducens paralysis and various defects of visual field. Ocular changes mainly occur in paraclinoid aneurysms and giant aneurysms. ..
  52. Tsutsumi M, Aikawa H, Kodama T, Iko M, Nii K, Matsubara S, et al. Symptomatic inferior cavernous sinus artery aneurysm associated with cerebral arteriovenous malformation. Neurol Med Chir (Tokyo). 2008;48:257-8 pubmed
    ..The present case illustrates the need for detailed evaluation of the external carotid artery and internal carotid artery vasculature in patients with cerebral AVMs. ..
  53. Hayashi M, Chernov M, Tamura N, Tamura M, Horiba A, Konishi Y, et al. Gamma knife radiosurgery for benign cavernous sinus tumors: treatment concept and outcomes in 120 cases. Neurol Med Chir (Tokyo). 2012;52:714-23 pubmed
    ..8%). Application of microradiosurgical treatment principles provides effective and safe management of benign cavernous sinus tumors and is associated with high probability of lesion shrinkage and minimal risk of complications. ..