Abstract
Sixth nerve palsy is an ominous sign in pediatric neurology. Due to the long and tortuous
course of the sixth (abducens) nerve, it is generally considered a sign of intracranial
pathology. Sixth nerve palsy is associated with increased intracranial pressure and
neoplasms, among other less frequent causes. In ∼5 to 15% of cases, no cause can be
identified. These cases are classified as idiopathic or “benign” and recovery is typically
complete. A recurrence of symptoms is very rare. We provide a rare case report of
recurrent benign sixth nerve palsy in a 5-year-old child. In addition, we provide
an overview of all earlier published cases of recurrent isolated sixth nerve palsy.
To date, only 72 pediatric patients with recurrent isolated sixth nerve palsy have
been reported. Young females with left-sided sixth nerve palsy and recent immunization
are at risk of recurrence. Pathophysiological mechanisms have been discussed, but
have yet to be clarified. Recurrent isolated sixth nerve palsy is only rarely associated
with severe causes and the need for extensive investigation may be questioned.
Keywords
sixth nerve palsy - abducens palsy - recurrence - child
