Aim: The aim of our study was to investigate the etiology of patients presenting with
double vision due to sixth cranial nerve palsy, and evaluate the relationships between the sixth cranial
nerve and vascular structures, with Constructive Interference in a Steady-State (CISS) sequence.
Materials and Methods: For this study, we evaluated the brain and orbital Magnetic Resonance
Imaging (MRI) of 26 patients retrospectively, who were diagnosed with binocular diplopia associated
with sixth nerve palsy between 2011 and 2016. The MRI images were assessed for those pathologies
that can cause diplopia. Additionally, the cisternal segment of the sixth cranial nerve was
assessed with CISS sequences for possible vascular contact or compression.
Results: Nine of the 26 patients were over 50 years old, with medical histories of diabetes mellitus,
hypertension, and hyperlipidemia/hypercholesterolemia. Microvascular angiopathy was considered
for diagnosis in those patients with sixth cranial nerve palsy, while the medical history was normal
in 17 of these 26 patients. Brain and orbital MRIs were used to detect any cavernous sinus pathology
and/or dural sinus vein thrombosis; however, the MRIs were normal in 9 of 17 patients with
sixth cranial nerve palsy. Therefore, vascular compression and/or contact were detected in these
patients using the CISS sequence, because diplopia can be caused by vascular contact or compression
of the sixth cranial nerve.
Conclusion: Patients with complaints of double vision and normal brain and orbital MRIs should
be evaluated using CISS sequences to show the relationships between the sixth cranial nerve and