6TH Nerve Palsy Flashcards
1
Q
Aetiology over 50
A
- most common is microvascular
- due to diabetes, hypertension and cholesterol
- giant cell arteritis
- stroke
- trauma
2
Q
Aetiology under 50
A
- multiple sclerosis
- increased intra cranial pressure
- severe ear infection
- cavernous sinus mass
- tumour
- trauma
- viral infection
- pituitary gland tumor
- pappilledema and 6th palsy = tumour
3
Q
Aetiology in children
A
- hydrocephalus
- congenital VI
- tumours most common
- trauma
- viral infection
- idiopathic
4
Q
6th N palsy features
A
- esotropia in primary position, greater in distance
- limited abduction of affected eye
- Px complains of uncrossed diplopia
- possible face turn to unaffected side
- field of BSV moved toward unaffected side
5
Q
Differential diagnosis
A
- myasthenia gravis
- Duane’s
- infantile esotropia
- mobeius syndrome
- medial wall fracture
6
Q
Investigations
A
- cover test
- lateral versions measurement
- saccades show hypomeropia of affected side
- smooth pursuits show limited abduction of affected eye
- lees screen
- smaller VF
- contralateral eye overacts
7
Q
Management of 6th nerve palsy
A
- prisms to join diplopia
- large diplopia - occlude one eye
- allow 6 months for recovery
- if only partial recovery, Botox surgery can be used to resign BSV in primary position
