Sixth Cranial Nerve Palsy and Vertigo Caused by Vertebrobasilar Insufficiency

Abstract

<jats:p>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.</jats:p>

Assessing Cranial Nerves in Physical Therapy Practice: Findings from a Cross-Sectional Survey and Implication for Clinical Practice

“…Commonly, patients with NAD IV present subtle transient antecedent neurological signs and symptoms or risk factors (i.e., acute onset of unusual headache or neck pain, recent trauma to the head or neck, and/or ischemic signs and symptoms, in younger people under 50 years) [14,15]. Clinicians should identify these during the subjective patient history and further verify during the neurological testing [8,[16][17][18][19], especially by the use of cranial nerve examination (CNE) because serious pathologies of the neck can potentially result in cranial nerve (CN) palsy (especially CNs V, VI, VIII, IX, X, and XII) [11,[20][21][22]. Physiotherapists therefore require skills in a wide range of neurological examination procedures required to screen all potential NAD IV clinical presentations [23].…”