Pediatric Cranial Nerve Palsies

Cranial nerve palsies in children offer unique challenges distinct from those in adults, and typically arise from congenital, traumatic, neoplastic, or postinfectious inflammatory disease. With rare reports of diplopia, diagnosis depends on indirect signs such as abnormal head posture, strabismus, or abnormal gaze. The oculomotor (III), trochlear (IV), and abducens (VI) nerves follow sometimes long, intricate courses from the brainstem to the target muscle(s) within the orbit. Accurate diagnosis requires integrating anatomic understanding with subtle clinical presentations and imaging findings, and management must emphasize limitations of congenital disease while relying on neural plasticity and adaptive behaviors. Advances in neuroimaging, molecular genetics, and surgical techniques have greatly improved time to diagnosis and treatment outcomes.