Presenting features suggestive for later recurrence of idiopathic sixth nerve paresis in children

Background Although idiopathic sixth (abducens) nerve paresis of childhood typically resolves within a few months, the paresis recurs in a minority of cases. The purpose of this study is to describe clinical features at presentation that are associated with later recurrence. Methods Retrospective literature review and novel case report. Results Thirty-five articles were reviewed, revealing 54 nonrecurrent and 41 recurrent cases. One previously unreported recurrent case is also included in our review. Patients with recurrence were typically girls ( p < 0.05) and were typically affected in the left eye ( p < 0.05). All children who initially presented under 14 months of age and/or whose initial presentation was associated with vaccination developed recurrence. Seventy-three percent of second episodes occurred within one year of initial presentation. No children who initially presented after 12 years of age developed recurrence. Conclusions When an otherwise normal child is diagnosed with idiopathic sixth nerve paresis, clinical features suggestive of later recurrence are female gender, left eye involvement, younger age, and recent vaccination. Recurrence is less likely if it has not occurred within one year of the initial event.