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Introduction <p>Isolated sixth nerve (CN VI) palsy can result from a variety of aetiologies. Comprehensive clinical evaluation and appropriate neuroimaging are essential for accurate diagnosis and prompt management.</p> Case Presentation <p>Patient 1, a 55-year-old male, with underlying diabetes and hypertension, presented with sudden onset of diplopia and was diagnosed with an ischemic aetiology. Patient 2, a 57-year-old male, experienced a 2-week history of binocular horizontal diplopia, accompanied by headache and constitutional symptoms. Imaging and histopathological examination revealed aggressive nasopharyngeal carcinoma. Patient 3, a previously healthy 31-year-old male, was diagnosed with Miller-Fisher syndrome based on clinical features and cerebrospinal fluid analysis. Two patients showed complete recovery, while one patient had partial recovery after 6 months.</p> Conclusion <p>While this case series may not present a novel mechanism of CN VI palsy, it provides a practical, real-world illustration of its varied presentations across different age groups and underlying pathologies. The cases underscore the importance of considering patient demographics, clinical context, and imaging findings in guiding diagnosis and management.</p>

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A Case Series of Isolated Sixth Nerve Palsy: Lesson from the Literature and Three Case Studies

  • 期刊论文

  • 发表日期：

    2025年10月7日

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  • Shi Ying Chan,
  • Jin Yi Yap,
  • Yi Wen Lim

摘要

Introduction

Isolated sixth nerve (CN VI) palsy can result from a variety of aetiologies. Comprehensive clinical evaluation and appropriate neuroimaging are essential for accurate diagnosis and prompt management.

Case Presentation

Patient 1, a 55-year-old male, with underlying diabetes and hypertension, presented with sudden onset of diplopia and was diagnosed with an ischemic aetiology. Patient 2, a 57-year-old male, experienced a 2-week history of binocular horizontal diplopia, accompanied by headache and constitutional symptoms. Imaging and histopathological examination revealed aggressive nasopharyngeal carcinoma. Patient 3, a previously healthy 31-year-old male, was diagnosed with Miller-Fisher syndrome based on clinical features and cerebrospinal fluid analysis. Two patients showed complete recovery, while one patient had partial recovery after 6 months.

Conclusion

While this case series may not present a novel mechanism of CN VI palsy, it provides a practical, real-world illustration of its varied presentations across different age groups and underlying pathologies. The cases underscore the importance of considering patient demographics, clinical context, and imaging findings in guiding diagnosis and management.