Spotlight on Isolated sixth nerve palsy

An isolated sixth nerve palsy may be a harbinger of underlying intracranial disease. Due to its long subarachnoid course, it may be damaged by downward shift of the brainstem as often occurs in increased or decreased intracranial pressure (“false-localizing sixth nerve palsy”). Alternatively, the sixth nerve may be involved in isolation by a compressive lesion in the cavernous sinus or along the clivus (“true-localizing sixth nerve palsy”), and specific attention on neuroimaging should be paid to these areas, especially in chronic or progressive cases. The most common causes of a sixth nerve palsy in an adult include ischemia, head trauma, and compression by a mass lesion, but inflammation, primary demyelination, and intracranial hypotension may also produce a sixth nerve palsy.

In this article, Dr. David Katz of Georgetown University and Howard University in Washington, DC reviews the manifestations, etiology, diagnosis, and management of isolated sixth nerve palsy.

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Spotlight on Mobius syndrome

Mobius syndrome is characterized by congenital partial or complete facial diplegia, often accompanied by other cranial nerve palsies and associated with other malformations of the limbs and orofacial structures. These features are observed in the newborn period, and modes of inheritance have been varied. In this clinical summary, Brian H Le MD of Reading Hospital and Medical Center incorporates recent clinical experiences with Mobius syndrome patients. As those with Mobius syndrome may have difficulties with facial expression of feelings, their actual emotions may be misperceived by others. For these reasons, the subject of self-perception has been more closely considered and examined in recent observations and studies.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Combined third, fourth, and sixth nerve palsies

Diplopia is a common complaint of patients with diseases of the central nervous system and usually is helpful for localization of pathology. A minority of patients complaining of diplopia have signs that indicate involvement of multiple ocular motor nerve palsies. These must be differentiated from single ocular motor nerve palsies, neuromuscular junction, myopathic disorders, and supranuclear disorders. Their recognition is also important because the differential diagnosis includes a higher frequency of mass and inflammatory lesions in the vicinity of the cavernous sinus, which may require urgent therapy. In this clinical summary, Dr. Heather Moss of the University of Illinois at Chicago discuss the manifestations, etiology, diagnosis, and management of multiple ocular motor palsies.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.