II. Causes
- Isolated Sixth Nerve Palsy
-
Brainstem Syndromes
- Raymond's Syndrome
- Includes CN 6 Palsy
- Contralateral Hemiparesis
- Millard-Gubler syndrome
- Includes CN 6 Palsy
- Ipsilateral CN 7 Palsy
- Contralateral Hemiparesis
- Foville's Syndrome
- Includes CN 6 Palsy
- Conjugate Gaze Palsy
- Ipsilateral Horner Syndrome
- Ipsilateral CN 5, CN 7, CN 8 palsies
- Raymond's Syndrome
- Subarachnoid space syndrome
- Hydrocephalus (Increased Intracranial Pressure)
- Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
- Hemorrhage, infection, inflammation and cancer within subarachnoid space may also injury CN 6
- Petrous apex syndrome
- Gradenigo Syndrome
- Includes CN 6 Palsy
- Ipsilateral Hearing Loss (CN 8)
- Ipsilateral facial pain (CN 5)
- Ipsilateral facial palsy (CN 7)
- Acoustic Neuroma
- Cerebellopontine angle meningioma
- Gradenigo Syndrome
-
Cavernous Sinus Syndrome
- Nasopharyngeal Cancer
- Internal Carotid Artery aneurysm (within Cavernous Sinus)
- Carotid-Cavernous fistula
- Tolosa-Hunt syndrome (Cavernous Sinus inflammation)
- Cavernous Sinus Meningioma
- Orbital Syndrome
- Includes Proptosis
- Miscellaneous
- Botulism (bilateral involvement)
- Wernicke's Encephalopathy (Conjugate Gaze Palsy)
III. Differential Diagnosis
- Internuclear Ophthalmoplegia
- Graves Disease (Exophthalmos)
- Myasthenia Gravis
- Duane's Syndrome
- Prior orbital blowout Fracture
- Near reflex spasm