• Ozlem Teksam, Ayse Gultekingil, Bahadir Konuskan, Goknur Haliloglu, Kader Karli Oguz, and Dilek Yalnizoglu.
• 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.
• Pediatr Emerg Care. 2016 May 1; 32 (5): 307-11.

ObjectivesSixth 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.MethodsFourteen patients who presented with acute SCN paralysis to pediatric emergency department during the last 10 years were examined.ResultsThe 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.ConclusionsOther 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.

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