We describe two patients with intracranial aneurysms who presented with isolated sixth nerve palsy. A 68-year-old woman with gradual onset of horizontal lateral diplopia was found to have a giant aneurysm at the junction of the petrous and cavernous portion of the internal carotid artery. A 58-year-old man presented with gradual onset of occipital pain followed by a sixth nerve palsy. He was found to have a distal anterior inferior cerebellar artery aneurysm which spontaneously thrombosed on subsequent neuroimaging studies. Although uncommon, isolated sixth nerve palsy can be the only neurological sign of an intracranial aneurysm.
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