Sixth nerve palsy

Purpose: To present five patients with VIth nerve palsy and ipsilateral Horner's Syndrome (HS), as a result of cavernous sinus alteration. Study design: Consecutive case series. Material and methods: Five patients presented abducens palsy with horizontal diplopia (3 in primary position and 2 in lateral gaze only) and ipsilateral HS. Apraclonidine 0.5% drops evidenced sympathetic denervation in all patients 40-60 min after instillation. All 5 cases had neuroimages (MRI in 3 cases, Computerized Tomography - CT in one case and Magnetic Resonance Angiography - MRA in one case) demonstrating cavernous sinus lesions; 2 meningiomas, 1 carotid-cavernous aneurism, 1 foreign body (bullet) and 1 squamous cell carcinoma. Conclusion: Lesions on the cavernous sinus need to be considered in cases of abducens nerve palsy and ipsilateral Horner's Syndrome.