Vertebrobasilar dolichoectasia (VBD) is a rare disorder characterized by elongation and tortuosity of the vertebrobasilar arteries. Clinicalmanifestations can range from ischemic stroke and progressive compression of cranial nerves and brainstem to cerebral hemorrhage andhydrocephalus. Here, we report a case of intermittent diplopia complaint when looking down with a tilted head position for 3 months. Hisneuro-ophthalmic examination was within normal limits. Further, magnetic resonance and angiographic images revealed a dolichoectaticbasilar artery compressing the right lateral brainstem. VBD treatment is controversial; there is still no effective treatment and onlycomplications can be treated. Surgical options may be useful in very limited situations, but advances in stent technology are promising in thetreatment of VBD. To our knowledge, no case in the literature describes intermittent trochlear nerve compression by VBD.