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Isolated sixth nerve palsy: a rare first presentation in multiple sclerosis
  1. Qi Xun Lim1,
  2. Fahid Ahmed2 and
  3. Sirjhun Patel2
  1. 1Ophthalmology, NHS Lothian, Edinburgh, UK
  2. 2Ophthalmology, NHS Tayside, Dundee, UK
  1. Correspondence to Dr Qi Xun Lim; qi.xun.95{at}


True isolated sixth nerve palsy as the initial presentation of multiple sclerosis (MS) is rare. MS is a chronic inflammatory, immune-mediated disease of the central nervous system. This is the most common cause of neurological disability in young adults. Common symptoms include acute episodes of muscle weakness, altered sensation, balance and gait disturbances, visual loss and bladder dysfunction.

Diagnosis of MS is supported with the incidence of symptomatic clinical episodes with subsequent cross-sectional imaging to confirm radiological lesions that are disseminated in space and time.

In the following report, we discuss the case of a woman in her 30s who presented to ophthalmology with a sixth nerve palsy in the absence of ocular or systemic disease. This is the first presentation of MS, a rare clinical event.

  • Cranial nerves
  • Multiple sclerosis
  • Ophthalmology
  • Visual pathway
  • Radiology

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  • Contributors Joint first authors QXL and FA contributed equally to this paper in conducting, planning and reporting the case. QXL planned and conducted literature reviews and reported the background and discussion, liaised with radiology for MRI for the patient and was the correspondence author. FA conducted and planned the case report, contributing to the write-up of the case presentation and subsequent management of patient. SP contributed as the second author in reviewing and editing the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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