Published: 2021-07-23

Isolated 6th cranial nerve palsy: a rare manifestation of tuberculosis

Shehnaz Kantharia, Rajesh A. Kantharia, Pradeepkran Reddy P.


Tuberculosis (TB) is a contagious infection that is usually caused by Mycobacterium tuberculosis bacteria. It usually affects the lungs and also spreads to the brain and spine. In the central nervous system, the neurological manifestations are numerous and varied and usually occur in two major forms, tuberculous meningitis and tuberculoma. Tuberculoma are well defined, granulomatous, space occupying lesions, which can occur anywhere in the central nervous system. Usually, brainstem tuberculoma can cause sixth and seventh cranial nerve affections along with motor and sensory symptoms, which are usually unilateral. Isolated abducens nerve palsy could be attributed to lesions of the nerve along their extra axial course and cause diplopia. Here we are presenting a case report of an 18-year-old boy with isolated sixth nerve palsy due to tuberculosis. The diagnosis of tuberculosis was achieved using interventional radiology for the purpose of biopsy. Using an image guided technique, we could avoid an open surgical procedure. 


6th cranial nerve palsy, Diplopia, Tuberculosis, Tuberculoma, CT guided biopsy

Full Text:



Garg RK. Tuberculosis of the central nervous system. Postgrad Med J. 1999;75(881):133-40.

Azarmina M, Azarmina H. The six syndromes of the sixth cranial nerve. J Ophthalmic Vis Res. 2013;8(2):160-71.

Graham C, Mohseni M. Abducens Nerve Palsy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: https://www.ncbi. Accessed on 2021 Apr 20.

Wikipedia contributors. Sixth nerve palsy. In Wikipedia, The Free Encyclopedia. Available at: Accessed on 2021 Apr 20.

Al Kabbani A, Farooq S. Abducens nerve palsy. Radiopedia. Available at: https://radiopaedia. org/articles/abducens-nerve-palsy-1. Accessed on 2021 Apr 20.

Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases. Arch Ophthalmol. 1981;99(1):76-9.

Lee MS, Galetta SL, Volpe NJ, Liu GT. Sixth nerve palsies in children. Pediatr Neurol. 1999;20(1):49-52.

Hamilton SR, Lessell S. Recurrent idiopathic lateral rectus muscle palsy in adults. Am J Ophthalmol. 1991;112(5):540-42.

Moster ML, Savino PJ, Sergott RC, Bosley TM, Schatz NJ. Isolated sixth-nerve palsies in younger adults. Arch Ophthalmol. 1984;102(9):1328-30.

Peters, George B 3rd. Cause and prognosis of nontraumatic sixth nerve palsies in young adults. Ophthalmology. 2002;109(10):1925-8.

Akhil K, Vimla B, Surender B, Harsh M, Singh H. Isolated clival metastasis as the cause of abducens nerve palsy in a patient of breast carcinoma. Indian J Ophthalmol. 2015;63(4):354-7.