title: Acute Abducens Nerve Paralysis in the Pediatric Emergency Department: Analysis of 14 Patients.
abstract: Sixth cranial nerve (SCN) palsy is an uncommon but important neurological problem in patients admitted to pediatric emergency department. The underlying etiology of SCN palsy has a wide range from viral infections to intracranial tumors; therefore, a careful and systematic approach is necessary while examining these patients.
  
  
  
  Fourteen patients who presented with acute SCN paralysis to pediatric emergency department during the last 10 years were examined.
  
  
  
  The age at the time of admission ranged between 14 months and 16 years (median, 9.5 years). Of the 14 patients, 5 were girls and 9 were boys. A total of 3 of the 14 patients had bilateral cranial nerve VI paralysis, and 9 patients had additional abnormal findings on neurological examination. Neuroimaging studies included cranial tomography (n = 3) and brain magnetic resonance imaging in all patients. The underlying etiology was malignancy (n = 3); glioma, medulloblastoma, acute lymphoblastic leukemia, and dural sinus thrombosis (n = 2); as well as Guillain-Barre syndrome (n = 2), multiple sclerosis (n = 1), pseudotumor cerebri (n = 1), and meningitis (n = 1). The remaining 4 patients had miscellaneous benign etiologies.
  
  
  
  Other lesions of primary brain tumors causing increased intracranial pressure constitute 50% of the underlying etiology, followed by Guillain-Barre syndrome (14.2%). However, these patients had neurological symptoms signs, in addition to diplopia or SCN paralysis. Patients admitted to pediatric emergency department with acute SCN paralysis should be examined in detail to disclose the underlying etiology especially if they present with additional clinical signs or symptoms.
authors: From the *Department of Pediatrics, Division of Pediatric Emergency Medicine, †Department of Pediatrics, Division of Pediatric Neurology, and §Department of Radiology, Hacettepe University Medical Faculty, Ankara, Turkey.
authors: Ozlem
authors: O
authors: Teksam
authors: Ayse
authors: A
authors: Gultekingil
authors: Bahadir
authors: B
authors: Konuskan
authors: Goknur
authors: G
authors: Haliloglu
authors: Kader Karli
authors: KK
authors: Oguz
authors: Dilek
authors: D
authors: Yalnizoglu
mesh_terms: D000010:Abducens Nerve / Q000473:pathology*; D020434:Abducens Nerve Diseases / Q000175:diagnosis* / Q000209:etiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies