The localization of abducens nerve lesions

Structure involved	Clinical presentation
Nuclear lesions
Abducens nucleus	Horizontal gaze palsy
	Möbius syndrome (gaze palsy with facial diplegia)
	Duane retraction syndrome (gaze palsy with globe retraction and narrowing of palpebral fissure with adduction)
Dorsolateral pons	Foville syndrome (ipsilateral gaze palsy, facial paresis, dysmetria occasionally with contralateral hemiparesis)
Lesions of the abducens fascicle
Abducens fascicle	Isolated CN VI palsy
Anterior paramedial pons	Ipsilateral CN VI palsy, ipsilateral CN VII palsy, contralateral hemiparesis (Millard-Gubler)
Prepontine cistern	May have contralateral hemiparesis
Lesion of abducens nerve (subarachnoid, petrous)
Petrous apex (Dorello canal)	CN VI palsy, deafness, facial (especially retroorbital) pain (Gradenigo)
Cavernous sinus
	Isolated CN VI palsy; CN VI palsy plus Horner syndrome; also may affect CN III, IV, V₁
Superior orbital fissure syndrome
	CN VI palsy with variable affection of CN III, IV, V₁; proptosis
Orbit
	CN VI palsy; visual loss; variable proptosis, chemosis, lid swelling

CN: cranial nerve; V₁: first division of fifth CN.

Modified from: Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology, Fourth 4th ed. Lippincott Williams & Wilkins, 2001.

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