PMC4074483_01
Photographs of the patient in different gaze positions: A, Convergence; B, Upward gaze; C, Primary position; D, Downward gaze; E, Left gaze; F, Right gaze.
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His eye movements were as follows: upward gaze was markedly restricted; however, downward, left, right and forward gazes were normal (Figure 1).
A, Magnetic resonance imaging (MRI) revealed a hypoplastic right vertebral artery and a dilated left vertebral artery (white arrows). B, Note the dilated vertebrobasilar artery, its elongation and association superiorly and inferiorly to the pons. Also note the hypoplastic right vertebral artery. C, Expanded basilar artery. D, MRI showing the basilar artery apex, left PCA, left SCA. E, Expanded basilar artery. F, MR angiography delineates the left vertebral and basilar arteries.
PCA, posterior cerebral artery; SCA, superior cerebellar artery
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Magnetic resonance imaging (MRI) revealed a hypoplastic right vertebral artery while the left vertebral artery was greatly expanded, elongated and tortuous (Figures 2A and E). Mechanical compression of the pons by the left vertebral artery was shown but findings of the IX, X, XI, and XII cranial nerves were not determined (Figure 2B). The vertebrobasilar artery runs along the sulcus basilaris superiorly to the pontomesencephalic junction (Figure 2C). There was no aneurysm at the origin of the posterior cerebral artery (PCA) and superior cerebellar artery (SCA) and this was also confirmed by MR angiography (Figures 2D and F).