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October 1993

Remitting Sixth Nerve Palsy in Skull Base Tumors

Author Affiliations

From the Department of Ophthalmology, Neuro-ophthalmology Unit, Harvard Medical School, and the Massachusetts Eye and Ear Infirmary, Boston, Mass.

Arch Ophthalmol. 1993;111(10):1391-1395. doi:10.1001/archopht.1993.01090100099035

Objective:  Spontaneous recovery of a sixth nerve palsy is thought to rule out a neoplastic origin. We reviewed cases of sixth nerve palsy that improved without treatment but that ultimately proved to be caused by a tumor at the base of the skull.

Design:  Case series.

Setting:  Hospital-based, neuro-ophthalmology referral practice.

Patients:  Seven patients with an age range from 7 to 61 years had sixth nerve palsy secondary to a slow-growing neoplasm at the skull base.

Main Outcome Measures:  Return of lateral rectus function and resolution of diplopia without intervention.

Results:  Seven patients with sixth nerve palsy caused by skull base tumors experienced spontaneous improvement of their deficit. Recovery time ranged from 1 week to 18 months. No patient was diabetic or had evidence of vascular disease. In one patient, the palsy improved once prior to becoming a fixed deficit, and spontaneous improvement occurred on two to five occasions in the other patients.

Conclusion:  Spontaneous recovery of a sixth nerve palsy can occur in the presence of an extramedullary compression by a tumor at the base of the brain. Possible mechanisms for recovery include remyelination, axonal regeneration, relief of transient compression (eg, resorption of hemorrhage), restoration of impaired blood flow, slippage of a nerve previously stretched over the tumor, or immune responses to the tumor.