A Case with Bilateral Dural Arteriovenous Fistulae Manifesting as Sequential Trochlear, Oculomotor Nerve Palsies

Purpose: We report a patient with bilateral dural arteriovenous fistulae (DAVF) who initially presented unilateral, isolated trochlear nerve palsy; and later contralateral, oculomotor palsy.Case summary: A 72-year-old male without any underlying disease or trauma history visited sudden vertical diplopia in both eyes that had developed 5 days prior. Brain magnetic resonance imaging (MRI) performed before his first visit was unremarkable. The eye movement test revealed hyperdeviation limitation of downgaze the left eye; we thus suspected ischemic palsy this indeed observed. However, did not improve limitations upper, medial gaze right after 3 months. Follow-up examinations (orbital computed tomography, brain MRI, cerebral angiography) DAVF running from to right. He underwent gamma-knife radiosurgery; then improved.Conclusions: Diplopia manifesting as paralysis an elderly may be caused by DAVF; always common paralytic strabismus. should considered during differential diagnosis further radiological needed.