Sixth cranial nerve palsy in giant cell arteritis: A systematic review

Haruki Sawada1, Yoshito Nishimura1,2, Hiromichi Tamaki3

1Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
2Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
3Immuno Rheumatology Center St. Luke’s International Hospital, Tokyo, Japan

Keywords: Abducens nerve, giant cell arteritis, six nerve palsy, systematic review.

Abstract

Objectives: This study aimed to review and describe isolated sixth cranial nerve or abducens nerve palsy that may present with subtle ophthalmoplegia in patients with giant cell arteritis (GCA).

Materials and methods: In this systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles using the keywords “cranial nerve six,” “abducens nerve,” and “giant cell arteritis” from their inception to December 22, 2022.

Results: Twenty-five articles, including seven observational studies and 18 cases, were included. While the incidence and prevalence of sixth nerve palsy in GCA were variable, up to 48% of diplopia in GCA were attributed to the sixth cranial nerve palsy, according to the observational studies included. While 88.2% had a resolution of symptoms with 40-50 mg/day of prednisone-equivalent corticosteroids, it took a median of 24.5 days until the resolution of symptoms from the initiation of treatment.

Conclusion: This review summarizes the current understanding of the characteristics of sixth nerve palsy in GCA. While most patients may have reversible clinical courses, a few can suffer from persistent ophthalmoplegia, which is a potentially missed yet crucial clinical finding in GCA. Increased awareness of the sixth nerve palsy in GCA is crucial.

Citation: Sawada H, Nishimura Y, Tamaki H. Sixth cranial nerve palsy in giant cell arteritis: A systematic review. Arch Rheumatol 2024;39(3):479-487. doi: 10.46497/ ArchRheumatol.2024.10528.

Ethics Committee Approval

Ethics Committee Approval: Since this is a systematic review, no ethics committee approval was required.

Author Contributions

Searched the literature, assessed the quality of the studies, drafted, and revised the manuscript: H.S., Y.N.; Both supervised the process: Y.N., H.T.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.