In this case report a nine-year-old girl develops bilateral abducens nerve paralysis, caused by vertebrobasilar dolichoectasia. Vertebrobasilar dolichoectasia is characterised by dilation, tortuosity and marked elongation of the vertebral and basilar arteries. Clinical findings result from the compression and displacement of adjacent structures. In this unusual case the child presented with a longstanding large angle esotropia (with four-year history) with bilateral lateral rectus underaction. Magnetic resonance imaging (MRI) revealed compression of both abducens nerves and the pons. Magnetic resonance angiography (MRA) confirmed the dolichoectatic basilar artery. This is an interesting finding in a rare condition, with a manifestation not found to be previously reported in the literature. Often cases of dolichoectasia are asymptomatic. MRA investigations should be considered in cases of unilateral or bilateral nerve paralysis when there is no known cause.

Bilateral abducens paralysis secondary to compression of abducens nerve roots be vertebrobasilar dolichoectasia.
Ayhan Tuzcu E, Bayaroullari H, Coskun M, et al.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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