Abducens Nerve Palsy Workup
- Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, FRCSC more...
See the list below:
Complete blood cell (CBC) count
Diabetes testing (glucose, glycosylated hemoglobin [HbA1C], glucose tolerance test)
Erythrocyte sedimentation rate and/or C-reactive protein
Acetylcholine receptor antibodies in the presence of variable strabismus or ptosis
The following are not mainstream tests for abducens palsy but can be considered:
Rapid plasma reagin test
Fluorescent treponemal antibody-absorption test
Antinuclear antibody test
MRI is indicated for the following:
Patients younger than 55 years with no vasculopathic history
Associated pain or other neurologic abnormality 
History of cancer
Bilateral sixth nerve palsy
In the event no marked improvement is seen or other nerves become involved
An LP should be considered if MRI results are negative.
If a presumed microvascular ischemic sixth nerve palsy does not improve within 3-4 months or if other cranial nerves become involved, a full medical, neurologic, and imaging workup should be performed.
Check history for diabetes mellitus, cancer, thyroid disease, and hypertension.
Ask about history of recent trauma, ear infections (children), and fluctuation of symptoms.
An otoscopic examination may be performed in children to rule out a complicated otitis media (consider an LP).
Rule out other cranial nerve involvement.
A temporal artery biopsy may be indicated if findings and laboratory studies suggest giant cell arteritis.
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