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Recurrent abducens nerve palsy and hypophosphatasia syndrome
  1. Neha Khade1,
  2. Simon Carrivick2,
  3. Carolyn Orr1 and
  4. David Prentice3
  1. 1 Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2 Department of Biochemistry, PathWest Laboratory Medicine Western Australia, Nedlands, Australian Capital Territory, Australia
  3. 3 Department of Internal Medicine, Royal Perth Hospital, Perth, Australian Capital Territory, Australia
  1. Correspondence to Dr Simon Carrivick, scarrivick{at}


A 47-year-old woman presented with six episodes of horizontal binocular double vision over a 2-year period. CT imaging was significant for extensive dural calcification in the spine and calcification of the skull base, likely involving Dorello’s canal. Biochemical testing revealed a persistently low alkaline phosphatase level. Recurrent nerve palsy may possibly be induced by mechanical compression of the sixth cranial nerve in Dorello’s canal from calcification due to hypophosphatasia syndrome.

  • cranial nerves
  • calcium and bone
  • metabolic disorders

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  • Contributors SC, NK and DP: manuscript preparation. SC, NK, DP and CO: all undertook the described medical investigations. SC and DP: overall responsibility.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.