Which physical findings are characteristic of abducens nerve palsy (sixth cranial nerve palsy)?

Updated: Nov 19, 2018
  • Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Answer

Physical findings of abducens nerve palsy include the following:

  • An esodeviation that increases on ipsilateral gaze and is often greater at a distance; prism measurements in different positions of gaze can reveal the magnitude of misalignment and its incomitance (asymmetry)
  • An isolated abduction deficit
  • Slowed ipsilateral saccades
  • Papilledema (if increased intracranial pressure)
  • Altered sensation in the V1 or V2 distribution with cavernous sinus lesions
  • Nystagmus (usually in children, ie, secondary to pontine glioma)
  • Otitis media
  • Petrous bone fracture
  • Tender, enlarged, nonpulsatile temporal arteries in giant cell arteritis
  • Horner syndrome (Foville brainstem syndrome, carotid oculosympathetic plexus involvement in cavernous sinus)
  • Contralateral hemiparesis may be seen in brainstem syndromes that involve the sixth cranial nerve (Millard-Gubler syndrome and Raymond syndrome)

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