Paget disease manifesting with compressive sixth-nerve palsy that resolved with intravenous zoledronic acid therapy.

P aget disease is a common condition characterized by increased bone turnover and abnormal bone deposition in the skull and vertebral column. This article describes a previously undiagnosed case of Paget disease in which the manifesting clinical symptom was gradually progressive diplopia from sixthnerve compression due to skull base hyperostosis. The sixth-nerve palsy, which was severe at the initial examination, slowly resolved after the patient was treated with intravenous zoledronic acid. To my knowledge, Paget disease has not previously been reported to manifest initially with diplopia, nor has diplopia due to this condition been reported to improve with medical therapy.