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S. J. Yousuf, A. O. Khan; Idiopathic Recurrent Sixth Cranial Nerve Paresis in Childhood: Case Report, Review of Literature, and Comparison to the Non-Recurrent Form. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4861.
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To report an original case and provide a complete review of the literature on the topic of recurrent idiopathic (or benign) sixth cranial nerve paresis in children for two purposes. First, to present data previously not compiled in order to further understanding of the epidemiological features and natural history of the condition. Second, to make a comparison based on initial presentation to the non-recurrent form to identify any factors that may predict likelihood of recurrence.
We conducted keyword searches in the databases of PubMed and Ovid MEDLINE. Review was not limited by year or language of publication.
A strong left sided and female predominance was observed in the recurrent form while a non-left sided and male predominance was observed in the singly occurring form. The average age at the time of initial presentation for patients later having recurrence was less than half that of patients reporting no recurrence. The most common finding presumed to be associated with the episode was fever or infection for both variants (although in different proportions). Most cases were self-resolving without any complications, although 20% of the recurrent cases were not. Differences between the two groups that were statistically significant (alpha < 0.05) were age, laterality, and associated findings at time of presentation.
While recurrent idiopathic (or benign) sixth nerve paresis in childhood remains a rare condition, enough cases have now been reported to identify important risk factors and to describe the clinical course. Based on our review of the literature, 84% of girls presenting with a unilateral left sided paresis had recurrence and all children initially presenting at less than 14 months of age had a recurrent episode.
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