Dr.JADHAV ANJALI MANCHAKRAO
Horizontal diplopia is the most debilitating symptom in a case of lateral rectus palsy. Trauma, systemic illness, vascular, neoplasm, iatrogenic etc. are the main causes of sixth nerve palsy. A 56 year old woman presented with diplopia of 1 month duration. She was on homeopathic treatment for thyroid since 3 years. Examination showed left lateral rectus paresis and an enlarged multinodular thyroid gland. Magnetic resonance imaging showed a large lesion at petrous apex encasing left internal carotid artery. Magnetic resonance imaging of thyroid showed multiple areas of necrosis and calcification suggestive of carcinoma of thyroid. A diagnosis of left sixth nerve palsy due to compressive metastasis from thyroid carcinoma was made. She was referred to oncologist for further management. This is a rare case of isolated sixth nerve palsy due to brain metastasis and it highlights the importance of neoplasm as a cause of sixth nerve palsy.
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