Aetiologies of acquired paediatric sixth nerve palsies in a U.K. based population

Abstract

Introduction: Due to the low incidence of sixth cranial nerve palsies in children there has been limited evidence published on this subject, especially from a U.K. based population. The incidence of aetiologies has been found to vary within the literature, especially with regards to neoplasms. The main aim of this study is to present the aetiologies of newly diagnosed paediatric sixth nerve palsies in a U.K based population. We also consider how the patients initially presented and if these palsies were isolated or associated with other neurological signs or symptoms.
Methods: Retrospective data collection was carried out on the medical records of fifty paediatric patients who presented to a large tertiary referral hospital in the South of the U.K with new onset sixth nerve palsy between 1st January 2007 and 31st December 2017. Data collected included: age, gender, ethnicity, unilateral versus bilateral, other signs and symptoms, aetiology, where patient first presented and whether the sixth was the first presenting feature
Results: Thirty-three (66%) patients had a sixth nerve palsy in conjunction with other neurological signs or symptoms and were considered non-isolated. Seventeen cases (34%) were found to be isolated. Aetiologies included high intracranial pressure (18%), neoplasm (14%), surgery for neoplasm (14%), viral (14%), infection (12%), trauma (8%), idiopathic (6%), benign space occupying lesion (4%), congenital (2%), inflammation (2%), Alexander disease (2%), Kawasaki syndrome (2%), diabetes (2%).
Conclusion: Our study found non-isolated sixth nerve palsies to be the most common presentation, with these patients having a high number of potentially sinister aetiologies with the most common being high intracranial pressure followed by post-surgery for neoplasm and neoplasm. Isolated sixth nerve palsies were more commonly due to viral or idiopathic aetiology, however two cases of benign space occupying lesion and one of neoplasm were still identified using neuroimaging.

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ORCID for Jay E. Self: orcid.org/0000-0002-1030-9963

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