Korean Journal of Audiology (대한청각학회지)

The Korean Audiology Society (대한청각학회)
권호 표지
DOI QR코드

DOI QR Code

Sixth Cranial Nerve Palsy and Vertigo Caused by Vertebrobasilar Insufficiency

  • Paik, Seung Won (Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine) ;
  • Yang, Hui Joon (Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine) ;
  • Seo, Young Joon (Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine)
  • Received : 2019.07.31
  • Accepted : 2019.08.29
  • Published : 2020.07.20
⟨ Previous Next ⟩

Abstract

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.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2019K1A3A1A47000527)

References

  1. Azarmina M, Azarmina H. The six syndromes of the sixth cranial nerve. J Opthalmic Vis Res 2013;8:160-71.
  2. Vallee L, Guilbert F, Lemaitre JF, Nuyts JP. [Benign paralysis of the 6th cranial nerve in children]. Ann Pediatr (Paris) 1990;37:303-5.
  3. Ugalde V, Rosen BS. Ischemic peripheral neuropathy. Phys Med Rehabil Clin N Am 2001;12:365-80. https://doi.org/10.1016/S1047-9651(18)30075-5
  4. Lhermitte F, Pages M. Abducens nucleus syndrome due to pontine haemorrhage. Cerebrovasc Dis 2006;22:284-5. https://doi.org/10.1159/000094331
  5. Ginsberg F, Peyster RG, Rose WS, Drapkin AJ. Sixth nerve schwannoma: MR and CT demonstration. J Comput Assist Tomogr 1988;12:482-4. https://doi.org/10.1097/00004728-198805010-00024
  6. Pham T, Wesolowski J, Trobe JD. Sixth cranial nerve palsy and ipsilateral trigeminal neuralgia caused by vertebrobasilar dolichoectasia. Am J Ophthalmol Case Rep 2018;10:229-32. https://doi.org/10.1016/j.ajoc.2018.02.029
  7. Baloh RW. Vertebrobasilar insufficiency and stroke. Otolaryngol Head Neck Surg 1995;112;114-7. https://doi.org/10.1016/S0194-5998(95)70309-8
  8. Jadhav A, Panczykowski D, Jumaa M, Aghaebrahim A, Ranginani M, Nguyen F, et al. Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion. J Neurointerv Surg 2018;10:1155-60. https://doi.org/10.1136/neurintsurg-2018-013810
  9. Hanus SH, Homer TD, Harter DH. Vertebral artery occlusion complicating yoga exercises. Arch Neurol 1977;34:574-5. https://doi.org/10.1001/archneur.1977.00500210076015
  10. Andres E, Serraj K, Zhu J, Vermorken AJ. The pathophysiology of elevated vitamin B12 in clinical practice. QJM 2013;106:505-15. https://doi.org/10.1093/qjmed/hct051
  11. Tiffin PA, MacEwen CJ, Craig EA, Clayton G. Acquired palsy of the oculomotor, trochlear and abducens nerves. Eye (Lond) 1996;10(Pt 3):377-84. https://doi.org/10.1038/eye.1996.77
  12. Miller RW, Lee AG, Schiffman JS, Prager TC, Garza R, Jenkins PF, et al. A practice pathway for the initial diagnostic evaluation of isolated sixth cranial nerve palsies. Med Decis Making 1999;19:42-8. https://doi.org/10.1177/0272989X9901900106
  13. Shan DE. Delayed ischemic hyperintensity of T1-weighted MRI. Stroke 2000;31:797-8.
  14. Pagano L, Marra R, De Stefano V, Di Donfrancesco A, Leone G. [Neurological complications of acute myeloid leukemia in adults]. Minerva Med 1986;77(1-2):13-7.
  15. Sachdeva V, Mittal V, Pathengay A, Kekunnaya R, Gupta A, Rao BV. Isolated abducens nerve palsy with hyperhomocysteinemia: association and outcomes. Indian J Ophthalmol 2013;61:598-600. https://doi.org/10.4103/0301-4738.121089
  16. Chi SL, Bhatti MT. The diagnostic dilemma of neuro-imaging in acute isolated sixth nerve palsy. Curr Opin Ophthalmol 2009;20:423-9. https://doi.org/10.1097/ICU.0b013e3283313c2f