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53. ABDUCENS NERVE – CRANIAL NERVE VI

Abducens Nerve: Cranial Nerve VI Medical Editor: Dr. Sarah Abimhamed

OUTLINE

I) ORIGIN OF THE NERVE Location of the Anterior Inferior Cerebellar Artery

II) COURSE OF THE NERVE:
The Anterior inferior cerebellar artery (AICA) originates from
III) STRUCTURES THE NERVE SUPPLIES
IV) CLINICAL CORRELATIONS the basilar artery, it is located near the cranial nerves
V) REVIEW QUESTIONS previously mentioned. Superiorly to AICA are the pontine
VI) REFERENCES branches. So, CN VI runs in between the AICA and the
pontine branches

It is important to know the relation of the artery to CN VI as

I) ORIGIN OF THE NERVE any type of lesion can lead to 6th nerve palsy.

The abducens nerve originates in the pons.

(A) ANATOMY
(1) FROM LATERAL VIEW
Facial nerve proper (motor fibers) move behind the 6th
cranial nerve (CN VI) and produce a little depression in 4th
ventricle (fluid filled cavity) this is called the facial
colliculus
The CN VI is located in the facial colliculus, from there the
nerve moves out and laterally.

Figure 3. AICA in relation to CN VI

Figure 1. Origin of CN VI

(2) ANTERIOR VIEW

CN VI comes from the midline between the pons-medulla
junctions. CN VII (facial nerve) and CN VIII
(vestibulocochlear nerve) are lateral to CN VI.

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Figure 2. CN VI in Relation to Other Cranial Nerves (CN VII and

CN VIII)

Abducens Nerve – Cranial Nerve VI NEURO PHYSIOLOGY: Note #53. 1 of 4

 II) COURSE OF THE NERVE:
From the facial colliculus, the abducens nerve moves out
and up the posterior cranial fossa (on the clivus)  enters
the petrous part of the temporal bone  pierces into the
canal (dorello’s canal) with the inferior petrosal sinus (vein)
 enters the cavity of the cavernous sinus  runs next to
the internal carotid artery  exits the cavernous sinus 
enters the superior orbital fissure  enters orbital cavity 
supplies the lateral rectus muscle to produce adduction
Figure 4. Course of the Abducens Nerve
Remember:
The cavernous sinus is a dural sinus. This is a space
between the periosteal layer and the meningeal layer.
In the wall of the cavernous sinus there are 4 nerves
running through it:
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- CN III (Oculomotor Nerve)
- CN IV (Trochlear Nerve)
- CN V1 (Ophthalmic division of trigeminal nerve)
- CN V2 (Maxillary division of trigeminal nerve.)
But the CN VI through the cavity with the ICA.
Figure 5. Contents of the Cavernous Sinus and its wall
2 of 4 NEURO PHYSIOLOGY: Note #53.
III) STRUCTURES THE NERVE SUPPLIES
The abducens nerve supplies the Lateral Rectus Muscle of
the eye.
Effects:
When the abducens stimulates the lateral rectus muscle 
it contracts and abducts the eye (lateral rotation of the
eyeball)
That is where it gets its name from:
ABDucens nerve  ABDuction
Extra ocular muscles and their functions image:
Figure 6. Extraocular Muscles
To remember which nerve supplies which extraocular
muscles:
LR6, SO4, ATR3
LR6 (lateral rectus supplied by 6th cranial nerve)
SO4 (superior oblique by the 4th cranial nerve)
ATR3 (All The Rest by the 3rd cranial nerve)
Abducens Nerve – Cranial Nerve VI
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 IV) CLINICAL CORRELATIONS
Different lesions in different locations along the path of the
abducens nerve can result in CN VI Palsy.
(1) IN THE BRAIN STEM
Tumor, blood vessels occlusion/infarction, abscess, multiple
sclerosis can demyelinate the axons of CNS  compress
or affect the nucleus of the CN VI
CLINICAL EFFECT
All these lesions can result in the Lateral rectus not being
able to contract  the eye will look inwards. This is called
unilateral internal strabismus at rest
If the patient turns their eyes laterally
The visual fields are affected  causing diplopia (double
vision)

(2) AROUND THE CEREBRAL ARTERY

If AICA develops vasculitis  affect the fibers of CN VI
coming from the brain stem

(3) PETROS PART OF THE TEMPORAL BONE

Hematoma in that area  high intracranial pressure  pull
on CN VI  tugging on the nerve at the edge of the bone
can damage it  leading to a nerve palsy

(4) CAVERNOUS SINUS

As CN VI runs in the cavernous sinus with ICA, any
Aneurysm or thrombosis of ICA, or infection, or a fissure
can also affect CN VI.

(5) SUPERIOR ORBITAL FISSURE Figure 7. Clinical Effect of CN VI Palsy - Eye showing Unilateral
Internal Strabismus
Trauma in this area  damage or fracture the bone 
damage the nerve

Which eye movement does the abducens nerve

V) REVIEW QUESTIONS produce?
a. Elevation
Which nerves are located lateral to the abducens
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nerve?
c. Adduction
a. Trigeminal Nerve & Accessory Nerve
d. Depression
b. Facial Nerve & Glossopharyngeal Nerve
c. Facial Nerve & Vestibulocochlear Nerve
In which of the following would an aneurysm in the
d. Glossopharyngeal Nerve & Vestibulocochlear Nerve
internal carotid artery damage the abducens
nerve?
Which clinically significant artery is located near the
a. Superior Orbital Fissure
abducens nerve?
b. Petros Part of Temporal Bone
a. Basilar Artery
c. Brain Stem
b. Vertebral Artery
d. Cavernous Sinus
c. Posterior Intercostal Cerebellar Artery
d. Anterior Inferior Cerebellar Artery
What is the result of 6th nerve palsy?
a. Unilateral Internal Strabismus At Rest
Which muscle does the abducens nerve supply?
b. Bilateral Internal Strabismus At Rest
a. Superior Oblique
c. Bilateral External Strabismus At Rest
b. Lateral Rectus
d. Unilateral External Strabismus At Rest
c. Inferior Oblique
d. Medial Rectus
What kind of damage to the orbital fissure can affect
the abducens nerve?
Which major artery runs with the abducens nerve in
a. Aneurysm
the cavernous sinus?
b. Trauma
a. Internal Carotid Artery
c. Vasculitis
b. Anterior Inferior Cerebellar Artery
d. Thrombosis
c. External Carotid Artery
d. Pontine branches
CHECK YOUR ANSWERS
Which canal does the abducens nerve pierce
through with the inferior petrosal sinus? VI) REFERENCES
a. Cavernous Canal
b. Clivus Canal
c. Doralo’s Canal
d. Dorello's Canal

Abducens Nerve – Cranial Nerve VI NEURO PHYSIOLOGY: Note #53. 3 of 4

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