Acute sixth nerve palsy in a young man, beware of the 'red herring'.

BACKGROUND

Cranial nerve palsies has several etiologies including vascular insufficiency, neoplasm, trauma and inflammation. Isolated sixth nerve palsy is an extremely rare presenting feature of leukemia.

AIM

We describe an unusual ocular presentation of a bilateral progressive sixth nerve palsy in a young male with a preceding head injury.

CONCLUSION

Acquired sixth nerve palsies in young adults may be due to trauma but in the absence of a definitive history other systemic processes must be outruled. We describe a case of bilateral sixth nerve palsy in a patient with ALL with no obvious CNS involvement. Potential etiological mechanisms are discussed.