Concomitant strabismus as a sign of intracranial disease

A child with a postoperative residual estropia of 16 diopters was suddenly found to have 75 D of esotropia for distance and 65 D of estropia for near. Full versions were noted that would be inconsistent with sixth nerve palsy. Divergence palsy is characterized by a substantially larger convergent strabismus for distance that, in this case, was only 10 D. One is left with the conclusion that concomitant strabismus may indicate the onset of intracranial disease that, in this case, was caused by an arteriovenous malformation.