Sixth Nerve Palsy, Abducens Palsy

Case Report

J Fam Med. 2016; 3(10): 1092.

Sixth Nerve Palsy, Abducens Palsy

Peris ME¹*, Sas MTA² and Yarrin HA²

¹MIR Family Physician, ABS4 Santa Coloma de Gramenet, Hospital Esperit Sant - ICS, Spain

²Family Physician, ABS4 Santa Coloma de Gramenet, InstitutCatalà de la Salut, Spain

*Corresponding author: M. Escofet Peris, MIR Family Physician, ABS4 Santa Coloma de Gramenet, Hospital Esperit Sant - ICS, Spain

Received: October 10, 2016; Accepted: November 09, 2016; Published: November 11, 2016

The Case

A 45-year-old female patient comes to the out-of-hours service of the Health centre with a 3-day history of binocular horizontal diplopia and holocraneal migraine. The patient has no history of trauma. Past medical history without relevance. The patient presents double vision producing a side-by-side image with both eyes open. In the physical exploration, diplopia to levo, supra and infraversion of his gaze is apparent. The rest of the neurological exploration was normal.

The Diagnosis

She was immediately referred to an ophthalmologist for examination. Ocular fundus examination and campimetry results were normal. There is a limitation of the abduction of the left eye. The patient is referred to Neurology; a cranial TAC is performed and results show nointracranial injuries. Upon analysis, all parameters are normal. The diagnostic orientation was idiopathic sixth nerve palsy.

Abduction limitations which mimic sixth nerve palsy may be a secondary effectof surgery, trauma or as a result of other conditions such as myasthenia gravis or thyroid eye disease. Other possible diagnosis: Mobius syndrome or Duane's syndrome [1-3].


The sixth nerve has the longest subarachnoid course of all cranial nerves and innervates the ipsilateral lateral rectus which abducts the eye. Lesions within each section are frequently recognizable by involvement of contiguous structures. Symptoms include binocular horizontal diplopia when looking to the side of the paretic eye (Figure 1).