In a review of 133 cases of isolated acquired sixth-nerve paresis in the pediatric age group, six etiologic categories were analyzed separately. More than a third of the cases were due to tumor; in the cases of tumor it was frequently noted that there was a history of trauma or there were findings suggestive of an infectious process. Of the ten cases with Gradenigo's syndrome, three were later discovered to have tumor. The presence of chronic papilledema and fifth-nerve involvement suggested tumor. Though the prognosis for the tumor group was poor, the patients whose disorder was due to trauma or inflammation often had complete spontaneous resolution of the nerve paresis.
Robertson DM, Hines JD, Rucker CW. Acquired Sixth-Nerve Paresis in Children. Arch Ophthalmol. 1970;83(5):574-579. doi:10.1001/archopht.1970.00990030574008