Sixth Nerve Palsy
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Transcript of Sixth Nerve Palsy
Case presentation
By: Imtiaz ur Rehman4th Year MBBS
Khyber Medical College Peshawar
Learning objectives• Sudden loss of vision• Sudden onset of
double vision• Swollen optic disc• Ocular injury• Child with white
pupillary reflex• Red eye
• Pain in the eye• Progressive dec in
vision• Child with squint• Swelling of eyelids• Watering of eye
• 7 yrs old boy with complain of misalignment of eyes from past 7-8 months
• No Hx of trauma, fever and fits
• Diplopia
Examinations• Visual acuity
RE= 6/6LE= 6/9 (improved with pinhole)
• PupilNormal and reactive to light
• Ocular movementsLimitation of abduction on left eyeLimitation of left levoelevationLimitation of left levodepression
• Distant direct ophthalmoscopy• Red reflex present
• Direct ophthalmoscopy• Normal optic discs and fundi
• Digital tonometry• Normal IOP in both eyes
• Visual field• Eyelids
• Normal
Tests performed for squint Hirshberg test
(15degrees)Krimsky test
(30 PD)Head turn(to left side)
SQUINT
Non functioning Left lateral rectus muscle
Sixth cranial nerve palsy
Due to
Due to
Course of 6th nervePons
Ponto medullary junction
Cavernous sinus
Superior orbital fissure
Orbit
Causes of sixth nerve palsy• Diabetes• Hypertension• Inflammation• Raised ICP• Trauma• Tumor
MRI scan
MRI report
Treatment• Removal of GliomaCurrent treatment
• Acetazolamide (AZM)• Deltacotril• Risek satchet 40 mg