Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature

Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature

Jane W Chan,1,2 Jeff Albretson3 1Department of Neurology, 2Department of Ophthalmology, College of Medicine, University of Arizona, Phoenix, AZ, USA; 3University of Nevada, Las Vegas, NV, USA Purpose: The etiology of recurrent isolated sixth nerve palsies in older adults has not...

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Autores principales: Chan JW, Albretson J
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2015
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Ophthalmology
RE1-994
Acceso en línea:https://doaj.org/article/a45bc5f649124d2d8670ad3f41c06542
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spelling oai:doaj.org-article:a45bc5f649124d2d8670ad3f41c065422021-12-02T11:14:07ZCauses of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature1177-5483https://doaj.org/article/a45bc5f649124d2d8670ad3f41c065422015-02-01T00:00:00Zhttp://www.dovepress.com/causes-of-isolated-recurrent-ipsilateral-sixth-nerve-palsies-in-older--peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483 Jane W Chan,1,2 Jeff Albretson3 1Department of Neurology, 2Department of Ophthalmology, College of Medicine, University of Arizona, Phoenix, AZ, USA; 3University of Nevada, Las Vegas, NV, USA Purpose: The etiology of recurrent isolated sixth nerve palsies in older adults has not been well described in the literature. Sixth nerve palsies presenting with a chronic, relapsing, and remitting course are uncommon, but can herald a diagnosis of high morbidity and mortality in the older population. Patients and methods: Our method was a retrospective case series study. A review of clinical records of 782 patients ≥50 years of age diagnosed with recurrent sixth nerve palsies was performed over a 10-year period from 1995–2005 in a neuro-ophthalmology clinic in Reno, Nevada. A review of the current literature regarding similar cases was also performed on PubMed. Results: Seven patients ≥50 years of age with chronic, recurrent sixth nerve palsies were identified. Five were males and two were females. Four of seven (57%) patients had structural lesions located in the parasellar or petrous apex cavernous sinus regions. One of seven (14.29%) had a recurrent painful ophthalmoplegic neuropathy (International Headache Society [IHS] 13.9), previously termed ophthalmoplegic migraine; one of seven (14.29%) presented with an intracavernous carotid artery aneurysm; and one of seven (14.29%) presented with microvascular disease. Conclusion: The clinical presentation of an isolated recurrent diplopia from a sixth nerve palsy should prompt the neurologist or ophthalmologist to order a magnetic resonance imaging (MRI) scan of the brain with and without gadolinium as part of the initial workup to rule out a non-microvascular cause, such as a compressive lesion, which can increase morbidity and mortality in adults >50 years of age. Keywords: cranial nerve palsy, skull base tumor, aneurysm, meningioma, ophthalmoplegic migraine, microvascular diseaseChan JWAlbretson JDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2015, Iss default, Pp 373-377 (2015)
institution DOAJ
collection DOAJ
language EN
topic Ophthalmology
RE1-994
spellingShingle Ophthalmology
RE1-994
Chan JW
Albretson J
Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature
description Jane W Chan,1,2 Jeff Albretson3 1Department of Neurology, 2Department of Ophthalmology, College of Medicine, University of Arizona, Phoenix, AZ, USA; 3University of Nevada, Las Vegas, NV, USA Purpose: The etiology of recurrent isolated sixth nerve palsies in older adults has not been well described in the literature. Sixth nerve palsies presenting with a chronic, relapsing, and remitting course are uncommon, but can herald a diagnosis of high morbidity and mortality in the older population. Patients and methods: Our method was a retrospective case series study. A review of clinical records of 782 patients ≥50 years of age diagnosed with recurrent sixth nerve palsies was performed over a 10-year period from 1995–2005 in a neuro-ophthalmology clinic in Reno, Nevada. A review of the current literature regarding similar cases was also performed on PubMed. Results: Seven patients ≥50 years of age with chronic, recurrent sixth nerve palsies were identified. Five were males and two were females. Four of seven (57%) patients had structural lesions located in the parasellar or petrous apex cavernous sinus regions. One of seven (14.29%) had a recurrent painful ophthalmoplegic neuropathy (International Headache Society [IHS] 13.9), previously termed ophthalmoplegic migraine; one of seven (14.29%) presented with an intracavernous carotid artery aneurysm; and one of seven (14.29%) presented with microvascular disease. Conclusion: The clinical presentation of an isolated recurrent diplopia from a sixth nerve palsy should prompt the neurologist or ophthalmologist to order a magnetic resonance imaging (MRI) scan of the brain with and without gadolinium as part of the initial workup to rule out a non-microvascular cause, such as a compressive lesion, which can increase morbidity and mortality in adults >50 years of age. Keywords: cranial nerve palsy, skull base tumor, aneurysm, meningioma, ophthalmoplegic migraine, microvascular disease
format article
author Chan JW
Albretson J
author_facet Chan JW
Albretson J
author_sort Chan JW
title Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature
title_short Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature
title_full Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature
title_fullStr Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature
title_full_unstemmed Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature
title_sort causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature
publisher Dove Medical Press
publishDate 2015
url https://doaj.org/article/a45bc5f649124d2d8670ad3f41c06542
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