[Skip to Content]
[Skip to Content Landing]
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.

Rucker CW.  Paralysis of the third, fourth and sixth cranial nerves . Am J Ophthalmol . 1958;46:787-794.
Rucker CW.  The causes of paralysis of the third, fourth and sixth cranial nerves . Am J Ophthalmol . 1966;61:1293-1298.
Rush JA, Younge BR.  Paralysis of cranial nerves II, IV, and VI: cause and prognosis in 1000 cases . Arch Ophthalmol . 1981;99:76-79.Article
Richards BW, Jones FR Jr, Younge BR.  Causes and prognosis in 4278 cases of paralysis of the oculomotor, trochlear and abducens cranial nerves . Am J Ophthalmol . 1992;113:489-496.
Volpe NJ, Liebsch NJ, Munzenrider JE, Lessell S.  Neuro-ophthalmologic findings in chordoma and chondrosarcoma of the skull base . Am J Ophthalmol . 1993;115:97-104.
Sakalas R, Harbison JW, Vines FS, Becker DP.  Chronic sixth nerve palsy: an initial sign of basisphenoid tumors . Arch Ophthalmol . 1975;93:186-190.Article
Currie J, Lubin JH, Lessell S.  Chronic isolated abducens paresis from tumors at the base of the brain . Arch Neurol . 1983;40:226-229.Article
Shrader EC, Schlezinger NS.  Neuro-ophthalmic evaluation of abducens nerve paralysis . Arch Ophthalmol . 1960;63:84-91.Article
Savino PJ, Hilliker JK, Casell GH, Schatz NJ.  Chronic sixth nerve palsies: are they really harbingers of serious intracranial disease? Arch Ophthalmol . 1982;100:1442-1444.Article
Moster ML, Savino PJ, Sergott RC, Bosley TM, Schatz NJ.  Isolated sixth nerve palsies in younger adults . Arch Ophthalmol . 1984;102:1328-1330.Article
Robertson DM, Hines JD, Rucker CW.  Acquired sixth nerve paresis in children . Arch Ophthalmol . 1970;83:574-579.Article
Berlit P.  Isolated and combined paresis of cranial nerves III, IV, VI: a retrospective study of 412 patients . J Neurol Sci . 1991;103:10-15.Article
Knox DL, Clark DB, Schuster FF.  Benign VI nerve palsies in children . Pediatrics . 1967;40:560-564.
Reinecke RD, Thompson WE.  Childhood recurrent idiopathic paralysis of the lateral rectus . Ann Ophthalmol . 1981;13:1037-1039.
Boger WP, Puliafito CA, Magoon EH, Sydnor CF, Knupp JA, Buckley EG.  Recurrent isolated sixth nerve palsy in children . Ann Ophthalmol . 1984;16:237-244.
Afifi AK, Bell WE, Bale JF, Thompson HS.  Recurrent lateral rectus palsy in childhood . Pediatr Neurol . 1990;6:315-318.Article
Hamilton SR, Lessell S.  Recurrent idiopathic lateral rectus muscle palsy in adults . Am J Ophthalmol . 1991;112:540-542.
Thomas JE, Yoss RE.  The parasellar syndrome: problems in determining etiology . Mayo Clin Proc . 1970;45:617-623.
Galetta SL, Sergott RC, Wells GB, Atlas SW, Bird SJ.  Spontaneous remission of a third nerve palsy in meningeal lymphoma . Ann Neurol . 1992;32:100-102.Article
Daly DD, Svien HJ, Yoss RE.  Intermittent cerebral symptoms with meningiomas . Arch Neurol . 1961;5:287-293.Article
Sunderland S. Nerves and Nerve Injuries . Baltimore, Md: Williams & Wilkins; 1968:127-134.
Schatz NJ, Savino PJ, Corbett JJ.  Primary aberrant oculomotor regeneration: a sign of intracavernous meningioma . Arch Neurol . 1977;34:29-32.Article
Cox TA, Wurster JB, Godfrey WA.  Primary aberrant oculomotor regeneration due to intracranial aneurysm . Arch Neurol . 1979;36:570-571.Article
Boghen D, Chartrand JP, Laflamme P, Kirkham T, Hardy J, Aube M.  Primary aberrant third nerve regeneration . Ann Neurol . 1979;6:415-418.Article