Abducens nerve palsy, or sixth nerve palsy, results in weakness of the ipsilateral lateral rectus muscle.
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Clinical presentation
Patients present with horizontal diplopia with an inability to abduct the ipsilateral eye, thereby resulting in an esotropia (nasal deviation of the eye).
Pathology
The abducens nerve has the longest subarachnoid course of all the cranial nerves.
Aetiology
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increased intracranial pressure (e.g. idiopathic intracranial hypertension, obstructive hydrocephalus)
results in downward displacement of the brainstem, causing stretching of the sixth nerve secondary to its location within Dorello canal
microvascular (e.g. diabetes mellitus)
subarachnoid space pathology (e.g. subarachnoid haemorrhage, meningitis, neurosarcoidosis, neoplasm)
cavernous sinus pathology (e.g. cavernous sinus thrombosis, intracavernous internal carotid artery aneurysm)
pontine pathology (e.g. stroke, neoplasm, multiple sclerosis)
clival pathology (i.e. Godtfredsen syndrome)
trauma
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