Isolated fourth- and sixth-nerve palsies are usually due to ischemia in older patients but can be seen in patients with elevated intracranial pressure with papilledema. Additionally, they may occur following head trauma. The slide shows a patient with a sixth-nerve palsy attempting to gaze to the right. Again, the only symptom a patient may have is double vision. If papilledema is absent and there are no neurologic signs or symptoms, patients with a fourth- or sixth-nerve palsy can be followed until resolution. If no resolution occurs after 3 months, imaging of the cranial cavity may be performed to exclude space-occupying lesions.