{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T18:44:08Z","timestamp":1778957048169,"version":"3.51.4"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neuropediatrics"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Sixth nerve palsy is an ominous sign in pediatric neurology. Due to the long and tortuous course of the sixth (abducens) nerve, it is generally considered a sign of intracranial pathology. Sixth nerve palsy is associated with increased intracranial pressure and neoplasms, among other less frequent causes. In \u223c5 to 15% of cases, no cause can be identified. These cases are classified as idiopathic or \u201cbenign\u201d and recovery is typically complete. A recurrence of symptoms is very rare. We provide a rare case report of recurrent benign sixth nerve palsy in a 5-year-old child. In addition, we provide an overview of all earlier published cases of recurrent isolated sixth nerve palsy. To date, only 72 pediatric patients with recurrent isolated sixth nerve palsy have been reported. Young females with left-sided sixth nerve palsy and recent immunization are at risk of recurrence. Pathophysiological mechanisms have been discussed, but have yet to be clarified. Recurrent isolated sixth nerve palsy is only rarely associated with severe causes and the need for extensive investigation may be questioned.<\/jats:p>","DOI":"10.1055\/s-0041-1741385","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T23:33:22Z","timestamp":1641512002000},"page":"151-158","source":"Crossref","is-referenced-by-count":4,"title":["Recurrent Isolated Sixth Nerve Palsy in Childhood\u2014Review on a Rare Phenomenon"],"prefix":"10.1055","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5606-2257","authenticated-orcid":false,"given":"Sandra D. K.","family":"Kingma","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, University of Antwerp, Antwerp University Hospital, Edegem, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berten","family":"Ceulemans","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, University of Antwerp, Antwerp University Hospital, Edegem, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,1,6]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/S0002-9394(98)00424-3","article-title":"Pediatric third, fourth, and sixth nerve palsies: a population-based study","volume":"127","author":"J M Holmes","year":"1999","journal-title":"Am J Ophthalmol"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1136\/bcr-2018-226895","article-title":"Recurrent abducens nerve palsy and hypophosphatasia syndrome","volume":"12","author":"N Khade","year":"2019","journal-title":"BMJ Case Rep"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/0887-8994(90)90023-T","article-title":"Recurrent lateral rectus palsy in childhood","volume":"6","author":"A K Afifi","year":"1990","journal-title":"Pediatr Neurol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1001\/archopht.1970.00990030574008","article-title":"Acquired sixth-nerve paresis in children","volume":"83","author":"D M Robertson","year":"1970","journal-title":"Arch Ophthalmol"},{"issue":"01","key":"ref5","first-page":"24","article-title":"Paralytic strabismus in children. Etiologic incidence and management of the third, fourth, and sixth nerve palsies","volume":"87","author":"R D Harley","year":"1980","journal-title":"Ophthalmology"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1177\/088307389200700310","article-title":"Etiology of lateral rectus palsy in infancy and childhood","volume":"7","author":"A K Afifi","year":"1992","journal-title":"J Child Neurol"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"633","DOI":"10.3171\/2013.9.PEDS13356","article-title":"Recurrent and self-remitting sixth cranial nerve palsy: pathophysiological insight from skull base chondrosarcoma","volume":"12","author":"P Frassanito","year":"2013","journal-title":"J Neurosurg Pediatr"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jaapos.2010.09.009","article-title":"Etiology and treatment of pediatric sixth nerve palsy","volume":"14","author":"P Merino","year":"2010","journal-title":"J AAPOS"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jaapos.2007.02.013","article-title":"Presenting features suggestive for later recurrence of idiopathic sixth nerve paresis in children","volume":"11","author":"S J Yousuf","year":"2007","journal-title":"J AAPOS"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1136\/adc.2008.142794","article-title":"Benign recurrent sixth (abducens) nerve palsies in children","volume":"94","author":"N R Mahoney","year":"2009","journal-title":"Arch Dis Child"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1038\/eye.2009.22","article-title":"Long-term follow-up of children with benign abducens nerve palsy","volume":"24","author":"V Sturm","year":"2010","journal-title":"Eye (Lond)"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1542\/peds.40.4.560","article-title":"Benign VI nerve palsies in children","volume":"40","author":"D L Knox","year":"1967","journal-title":"Pediatrics"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1001\/archopht.1983.01040010607016","article-title":"Benign recurrent sixth nerve palsies in childhood. Secondary to immunization or viral illness","volume":"101","author":"D B Werner","year":"1983","journal-title":"Arch Ophthalmol"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"300060520986702","DOI":"10.1177\/0300060520986702","article-title":"Two cases of benign abducens nerve palsy in children and their long-term follow-up","volume":"49","author":"T Zhang","year":"2021","journal-title":"J Int Med Res"},{"issue":"105","key":"ref15","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/1471-2334-12-105","article-title":"Recurrent 6th nerve palsy in a child following different live attenuated vaccines: case report","volume":"12","author":"D R Cheng","year":"2012","journal-title":"BMC Infect Dis"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jaapos.2011.03.015","article-title":"Recurrent sixth nerve palsy associated with a hypoplastic Dorello's canal","volume":"15","author":"C Chua","year":"2011","journal-title":"J AAPOS"},{"issue":"03","key":"ref17","first-page":"237","article-title":"Recurrent isolated sixth nerve palsy in children","volume":"16","author":"W P Boger III","year":"1984","journal-title":"Ann Ophthalmol"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/000992288502400311","article-title":"Benign recurrent isolated VI nerve palsy of childhood","volume":"24","author":"S C Sullivan","year":"1985","journal-title":"Clin Pediatr (Phila)"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/0065955X.2000.11982245","article-title":"Benign recurrent sixth nerve palsy","volume":"50","author":"D L Mickelson","year":"2000","journal-title":"Am Orthopt J"},{"key":"ref20","first-page":"8276256","article-title":"Benign recurrent sixth nerve palsy in a child","volume":"2017","author":"R Gon\u00e7alves","year":"2017","journal-title":"Case Rep Ophthalmol Med"},{"key":"ref21","first-page":"734516","article-title":"Benign recurrent sixth (abducens) nerve palsy following measles-mumps-rubella vaccination","volume":"2015","author":"A Bourtoulamaiou","year":"2015","journal-title":"Case Rep Pediatr"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.3928\/01913913-20140923-01","article-title":"Benign recurrent sixth nerve palsy in an infant","volume":"51","author":"C Jukes","year":"2014","journal-title":"J Pediatr Ophthalmol Strabismus"},{"issue":"04","key":"ref23","first-page":"287","article-title":"Successful treatment with intravenous steroid pulse therapy of a boy with recurrent idiopathic sixth nerve palsy. No to hattatsu =","volume":"46","author":"K Yamada","year":"2014","journal-title":"Brain Dev"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s00381-012-1929-z","article-title":"The role of neuroimaging in the evaluation process of children with isolated sixth nerve palsy","volume":"29","author":"G Dotan","year":"2013","journal-title":"Childs Nerv Syst"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1038\/eye.2001.122","article-title":"Recurrent sixth nerve palsy following measles mumps rubella vaccination","volume":"15","author":"A McCormick","year":"2001","journal-title":"Eye (Lond)"},{"issue":"03","key":"ref26","first-page":"638","article-title":"Benign, recurrent sixth nerve palsy in two children","volume":"53","author":"R Kulkarni","year":"2011","journal-title":"Bombay Hosp J"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jaapos.2008.12.137","article-title":"Recurrent isolated sixth nerve palsy after consecutive annual influenza vaccinations in a child","volume":"13","author":"Y I Leiderman","year":"2009","journal-title":"J AAPOS"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3928\/01913913-20090101-18","article-title":"Benign recurrent abducens (sixth) nerve palsy","volume":"46","author":"V Okutan","year":"2009","journal-title":"J Pediatr Ophthalmol Strabismus"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1076\/stra.12.1.13.29015","article-title":"Benign recurrent abducens (6th) nerve palsy in two children","volume":"12","author":"C M Knapp","year":"2004","journal-title":"Strabismus"},{"issue":"05","key":"ref30","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/0887-8994(93)90110-X","article-title":"Benign abducens nerve palsy of childhood","volume":"9","author":"H A Cohen","year":"1993","journal-title":"Pediatr Neurol"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1080\/0065955X.1990.11981821","article-title":"Recurrent sixth nerve palsy","volume":"40","author":"L M Verslype","year":"1990","journal-title":"Am Orthopt J"},{"issue":"05","key":"ref32","first-page":"303","article-title":"[Benign paralysis of the 6th cranial nerve in children]","volume":"37","author":"L Vall\u00e9e","year":"1990","journal-title":"Ann Pediatr (Paris)"},{"issue":"02","key":"ref33","first-page":"107","article-title":"[Benign isolated 6th nerve paralysis in children. Developmental aspects apropos of 9 new cases]","volume":"3","author":"B Roussat","year":"1989","journal-title":"Ophtalmologie"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1080\/0065955X.1983.11981597","article-title":"Benign sixth nerve palsy of childhood","volume":"33","author":"H S Metz","year":"1983","journal-title":"Am Orthopt J"},{"issue":"09","key":"ref35","first-page":"1037","article-title":"Childhood recurrent idiopathic paralysis of the lateral rectus","volume":"13","author":"R D Reinecke","year":"1981","journal-title":"Ann Ophthalmol"},{"issue":"03","key":"ref36","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3928\/0191-3913-19810501-07","article-title":"Benign recurrent VI nerve palsy in childhood","volume":"18","author":"W W Bixenman","year":"1981","journal-title":"J Pediatr Ophthalmol Strabismus"},{"issue":"05","key":"ref37","doi-asserted-by":"crossref","first-page":"323","DOI":"10.3928\/0191-3913-19800901-14","article-title":"Recurrent, isolated, post-febrile abducens nerve palsy","volume":"17","author":"I Sternberg","year":"1980","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"ref38","first-page":"77","article-title":"Case history: recurrent sixth nerve paralysis in a child","volume":"17","author":"J Hunter","year":"1979","journal-title":"Aust Orthopt J"},{"issue":"04","key":"ref39","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3928\/0191-3913-19721101-07","article-title":"Recurrent sixth nerve palsy with amblyopia and secondary esotropia in a child","volume":"9","author":"A Riazi","year":"1972","journal-title":"J Pediatr Ophthalmol Strabismus"},{"issue":"44","key":"ref40","first-page":"1662","article-title":"Benign recurrent abducens palsy in children","volume":"46","author":"A M Barnett","year":"1972","journal-title":"S Afr Med J"}],"container-title":["Neuropediatrics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1741385.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T14:21:13Z","timestamp":1730816473000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1741385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,6]]},"references-count":40,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2022,7,15]]},"published-print":{"date-parts":[[2022,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1741385","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0174-304X","1439-1899"],"issn-type":[{"value":"0174-304X","type":"print"},{"value":"1439-1899","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,6]]}}}