Etiology and treatment of pediatric sixth nerve palsy

Merino, P.; Liaño, P. Gómez de; Villalobo, Jose Miguel Caro; Franco, G.; Liaño, Rosario Gómez de

doi:10.1016/j.jaapos.2010.09.009

Cited by 48 publications

(34 citation statements)

References 15 publications

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“…The leading causes of acquired abducens nerve palsy are neoplasm and trauma [2,4]. Inflammatory palsies are less frequent and can recover after appropriate treatment, as was the case in our patient [2]. …”

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confidence: 65%

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Abducens nerve palsy during sepsis

et al. 2015

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A 28-year-old man presented with fever, myalgia and swelling of the left forearm. The history was remarkable for cystic fibrosis, pulmonary and renal transplants complicated by rejection, compensated diabetes mellitus, and hemodialysis fistula on the left forearm. Two days later, the fever disappeared, but the patient complained of sudden onset diplopia and left ocular pain. Neurologic examination revealed a left abduction deficit, consistent with left abducens nerve palsy (Fig. 1a).Pharmacologic history included mycophenolate mofetil, tacrolimus, prednisone, antihypertensive drugs, and insulin. Blood studies showed high CRP (9.38 mg/dl; n.v. \0.5) and procalcitonin (95.56 ng/ml; n.v. 0.002-0.06). Blood cultures were negative. Treatment with daptomycin 6 mg/ kg/day every other day and meropenem 1 g/day was started. Viral and antibody testing were negative. A brain MRI without contrast was normal. T2-weighted MRI of the left forearm revealed hyperintensity of the muscular and subcutaneous tissues, consistent with inflammatory edema (Fig. 1b). Two weeks later, blood studies showed normal CRP (0.42 mg/dl; n.v.\0.5) and near normal procalcitonin (2.57 ng/ml; n.v. 0.02-0.06). Six weeks later, ocular motility was normal, and an MRI of the left forearm showed reduction of muscle edema. The sixth cranial nerve (abducens nerve) innervates the lateral rectus muscle, which is responsible for abducting the eye [1]. Abducens nerve palsies occur more frequently in children while they are unusual in young adults [2,3]. The leading causes of acquired abducens nerve palsy are neoplasm and trauma [2,4]. Inflammatory palsies are less frequent and can recover after appropriate treatment, as was the case in our patient [2].

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confidence: 65%

“…The sixth cranial nerve (abducens nerve) innervates the lateral rectus muscle, which is responsible for abducting the eye [1]. Abducens nerve palsies occur more frequently in children while they are unusual in young adults [2,3]. The leading causes of acquired abducens nerve palsy are neoplasm and trauma [2,4].…”

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confidence: 99%

Abducens nerve palsy during sepsis

et al. 2015

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“…3 Özellikle malignensiler kronik izole altıncı sinir felcine sebebiyet verebildiklerinden altıncı sinir felci olduğu düşünülen çocuklarda nörolojik görüntülemenin gerekliliği uzmanların üzerinde anlaştığı bir konudur. 4 Görüntüleme yöntemlerinde patoloji saptanmayan ve lateralize edici bulgusu olmayan çocuk-larda altıncı sinir felçlerinde akla gelecek diğer sebepler arasında kas ve siniri ilgilendiren Myastenia Gravis gibi durumlar ile oftalmopleji ile sonuçlana-bilen demyelinizan hastalıklar bulunmaktadır.…”

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Unilateral Sixth Nerve Palsy Following Upper Respiratory Tract Infection

Bostanci¹,

Ayvaz²,

Karatepe³

et al. 2018

Turkiye Klinikleri J Ophthalmol

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“…The involvement of other cranial nerves can be a sign of polyneuropathy or malignancy and a concomitant involvement of the VI pair reveals a pathology of the brainstem, V, VI, and VIII, pathology of the petrous apex, and the IX, X, and XI, pathology of the skull base. 1,5,6 Although most cases of facial palsy are idiopathic, their diagnosis can be determined only after having ruled out all other possible etiologies. 7,8 The prevalence of BP is about four times lower for those patients who are up to 10 years old compared to adults; no significant difference between the sexes has been observed.…”

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confidence: 99%

Low-Level Laser Therapy in Pediatric Bell's Palsy: Case Report in a Three-Year-Old Child

Fontana

Bagnato

2013

The Journal of Alternative and Complementary Medicine

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Objectives: The objective of this study was to apply low-level laser therapy (LLLT) to accelerate the recovery process of a child patient with Bell's palsy (BP). Design: This was a prospective study. Subject: The subject was a three-year-old boy with a sudden onset of facial asymmetry due to an unknown cause. Materials and methods: The low-level laser source used was a gallium aluminum arsenide semiconductor diode laser device (660 nm and 780 nm). No steroids or other medications were given to the child. The laser beam with a 0.04-cm 2 spot area, and an aperture with approximately 1-mm diameter, was applied in a continuous emission mode in direct contact with the facial area. The duration of a laser session was between 15 and 30 minutes, depending on the chosen points and the area being treated. Light was applied 10 seconds per point on a maximum number of 80 points, when the entire affected (right) side of the face was irradiated, based on the small laser beam spot size. According to the acupuncture literature, this treatment could also be carried out using 10-20 Chinese acupuncture points, located unilaterally on the face. In this case study, more points were used because the entire affected side of the face (a large area) was irradiated instead of using acupuncture points. Outcome measures: The House-Brackmann grading system was used to monitor the evolution of facial nerve motor function. Photographs were taken after every session, always using the same camera and the same magnitude. The three-year-old boy recovered completely from BP after 11 sessions of LLLT. There were 4 sessions a week for the first 2 weeks, and the total treatment time was 3 weeks. Results: The result of this study was the improvement of facial movement and facial symmetry, with complete reestablishment to normality. Conclusions: LLLT may be an alternative to speed up facial normality in pediatric BP.

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Etiology and treatment of pediatric sixth nerve palsy

Cited by 48 publications

References 15 publications

Abducens nerve palsy during sepsis

Abducens nerve palsy during sepsis

Unilateral Sixth Nerve Palsy Following Upper Respiratory Tract Infection

Low-Level Laser Therapy in Pediatric Bell's Palsy: Case Report in a Three-Year-Old Child

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