J Audiol Otol.  2020 Jul;24(3):157-160. 10.7874/jao.2019.00311.

Sixth Cranial Nerve Palsy and Vertigo Caused by Vertebrobasilar Insufficiency

  • 1Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 2Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, Korea


A 38-year-old woman presented with a week’s history of binocular horizontal double vision and acute vertigo with gaze-induced nystagmus. We considered a diagnosis of one of the six syndromes of the sixth cranial nerve and evaluated several causes. She had history of severe anemia, vitamin B12 deficiency, and hypertension. Magnetic resonance imaging with angiography showed stenosis of the right vertebral artery and hyperintensity on both basal ganglia. As we describe here, we should consider vertebrobasilar insufficiency as a cause for sixth cranial nerve palsy if a patient has high risk for microvascular ischemia, even in the absence of acute brain hemorrhage or infarction.


Sixth nerve palsy; Vertebrobasilar insufficiency; Magnetic resonance image; Vertigo
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