A rare case of cavernoma presenting as fourth nerve palsy

This is a rare case of cavernoma which presented with left fourth nerve palsy. A 36-year-old male came with sudden onset binocular vertical diplopia for 1 month. On examination, there was a restriction in intorsion on depression in left eye. Magnetic resonance imaging (MRI) of brain and orbits was suggestive of cavernoma in dorsal aspect of midbrain in the right paramedian periaqueductal region. Usually cavernomas present with seizures, headache, decrease in function, hypothalamic/hypophyseal disorders. Presentation of cavernoma in a neuro-ophthalmic clinic is rare.