Clinical Features of the Sixth Cranial Nerve Palsy

Eun Ryung Han; Key Hwan Lim

doi:10.3341/jkos.2008.49.8.1323

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Han and Lim: Clinical Features of the Sixth Cranial Nerve Palsy

Original Article

J Korean Ophthalmol Soc 2008;49(8):1323-1329.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.8.1323

Clinical Features of the Sixth Cranial Nerve Palsy

Eun Ryung Han, M.D., Key Hwan Lim, M.D., Ph.D.

Department of Ophthalmology, School of Medicine, Ewha Womans University, Seoul, Korea

Address reprint requests to Key Hwan Lim, M.D., Ph.D. Department of Ophthalmology, School of Medicine, Ewha Womans University Mokdong Hospital #911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: Limkh@ewha.ac.kr

Received 6 May 2008 Accepted 11 October 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical features and natural course of sixth cranial nerve palsy.

Methods

We reviewed the medical records of 50 patients who were diagnosed with sixth nerve palsy from January 2000 to December 2006 to analyze the age of onset, etiology, recovery, and natural course of this disease.

Results

The mean age at onset was 43.2 years old. Vascular disease (n=17, 34.0%) was the most common cause of sixth cranial nerve palsy, followed by undetermined causes (n=14, 28.0%), trauma (n=10, 20.0%), and neoplasm (n=3, 6.0%). According to age group, vascular disease (n=7, 46.7%) was the most common cause in patients in their fifties and sixties, and trauma and undetermined causes (n=10, 76.9%) were the most common causes of this disease in patients in their twenties and thirties. Of the 40 patients who were followed up for more than 6 months, 28 (70.0%) showed improvement of paresis and 26 (65.0%) achieved complete recovery. The mean period to recovery was 3.7 months. No significant differences were observed in sex, age, laterality, and etiology between non-recovered and completely-recovered patients, but completely-recovered patients showed a significantly smaller initial angle of deviation than non-recovered patients.

Conclusions

Vascular disease was the most common etiology of sixth nerve palsy. Sixty-five percent of patients showed spontaneous complete recovery, and completely-recovered patients showed a significantly smaller initial angle of deviation compared to that of non-recovered patients.

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Keywords: Etiology, Recovery, Sixth nerve palsy

References

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Figure 1.

Frequency and etiology of sixth nerve palsy by decade of life.

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Figure 2.

Kaplan-Meier analysis of recovery rate of 6th cranial nerve palsy.

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Table 1.

Age distribution of 6th cranial nerve palsy

Age	No.(%) of patients
<10	3 (6.0)
10~19	3 (6.0)
20~29	7 (14.0)
30~39	6 (12.0)
40~49	6 (12.0)
50~59	15 (30.0)
60~69	7 (14.0)
70<	3 (6.0)
Mean±SD (years)	43.2±19.1
Range (years)	0~77

Table 2.

Demographics according to etiology of 6th cranial nerve palsy

Causes	Vascular	Trauma	Neoplasm	Aneurysm	Undetermined	Others	Total
Age (years, mean±SD)	59.6±9.3	28.5±17.6	39.3±29.7	41.5±17.7	37.9±15.7	32.0±14.4	43.2±19.1
Sex
Male	9	9	1	1	6	2	28
Female	8	1	2	1	8	2	22
Laterality
Right	12	2	1	1	5	1	22
Left	5	5	1	1	7	2	21
Bilateral	0	3	1	0	2	1	7
Angle of Deviation	24.8±10.0	27.9±22.5	31.7±16.1	20.5±6.4	26.2±12.2	19.0±8.2	25.6±13.7
(PD, mean±SD)

Total	17 (34.0)	10 (20.0)	3 (6.0)	2 (4.0)	14 (28.0)	4 (8.0)	4 (8.0)

Table 3.

Recovery rate according to etiology of 6th cranial nerve palsy

Causes	Complete Recovery (A)	Partial Recovery (B)	Persistence (C)	Complete Recovery Rate [(A)/(A+B+C)]	Total Recovery Rate [(A+B)/(A+B+C)]	Mean Period of Complete Recovery (months)
Vascular	9	0	3	75.0%	75.0%	4.1±2.3
Trauma	5	0	4	55.6%	55.6%	4.2±0.8
Neoplasm	2	0	1	66.7%	66.7%	1.0±0.0
Aneurysm	1	0	1	50.0%	50.0%	8.0±0.0
Undetermined	6	1	3	60.0%	70.0%	3.5±1.8
Other	3	1	0	75.0%	100.0%	2.3±1.5

Total	26	2	12	65.0 %	75.0 %	3.7±2.0

Table 4.

Recovery rate according to degree of paralysis

Degree of Paralysis	Complete Recovery (A)	Partial Recovery (B)	Persistence (C)	Complete Recovery Rate [(A)/(A+B+C)]	Total Recovery Rate [(A+B)/(A+B+C)]	Mean Period of Complete Recovery (months)
-1	3	0	0	100.0 %	100.0 %	3.7±2.3
-2	16	1	7	66.7 %	70.8 %	3.4±2.1
-3	5	1	5	45.5 %	54.5 %	4.2±2.3
-4	2	0	0	100.0 %	100.0 %	5.0±1.4

Total	26	2	12	65.0 %	80.0 %	3.7±2.0

Table 5.

Comparisons of completely recovered group and persistent group

		Completely Recovered group	Persistent Group	p-value
Sex	Male	15	5	>0.05
	Female	11	7
Laterality	Right	7	6
	Left	16	3	>0.05
	Bilateral	3	3
Age (years, mean±SD)		38.3±19.5	46.3±16.4	>0.05
Causes	Vascular	9	3
	Trauma	5	4
	Neoplasm	2	1
	Aneurysm	1	1	>0.05
	Undetermined	6	3
	Others	3	0
Initial Angle of Deviation		22.4±8.5	34.9±20.7	<0.05
(PD, mean±SD)

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