RT Journal Article SR Electronic T1 Isolated sixth nerve palsy: a rare first presentation in multiple sclerosis JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e247928 DO 10.1136/bcr-2021-247928 VO 15 IS 5 A1 Qi Xun Lim A1 Fahid Ahmed A1 Sirjhun Patel YR 2022 UL http://casereports.bmj.com/content/15/5/e247928.abstract AB 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.