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Tien CW, Donaldson L, Parra-Farinas C, Micieli JA, Margolin E. Sensitivity of Magnetic Resonance Imaging of the Medial Longitudinal Fasciculus in Internuclear Ophthalmoplegia. J Neuroophthalmol 2024; 44:107-111. [PMID: 36626595 DOI: 10.1097/wno.0000000000001783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Internuclear ophthalmoplegia (INO) is a result of insult to the medial longitudinal fasciculus (MLF). Clinicoradiological correlation in patients with INO has been reported to be poor; however, prior studies have used low resolution MRI imaging techniques and included patients with subclinical INO. We aimed to determine the sensitivity of modern MRI interpreted by a specialist neuroradiologist to detect clinically evident INO. METHODS A retrospective chart review of patients in 2 tertiary University-affiliated neuro-ophthalmology practices with the diagnosis of INO. MRI scans of all patients were reviewed and interpreted by a fellowship-trained neuroradiologist for the presence of lesion in MLF and concordance with the original imaging report. RESULTS Forty-five patients were included in the study: 33 with demyelinating disease, 11 with stroke, and 1 with intracranial mass. A visible MLF lesion was present in 25/33 demyelinating cases and 7/11 ischemic cases. Lesions in 2 cases in each group were identified only after review by a fellowship-trained neuroradiologist. In demyelinating INO, patients with a visible MLF lesion were more likely to show other brainstem (72%) and supratentorial (51%) white matter lesions. CONCLUSIONS In 25% of patients with demyelinating INO and 33% of patients with ischemic INO, no visible lesion was identified on current high-quality MRI imaging. Review of imaging by a neuroradiologist increased the possibility of lesion been identified.
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Affiliation(s)
- Chi-Wei Tien
- Faculty of Medicine (C-WT), University of British Columbia, Vancouver, Canada; Department of Ophthalmology and Vision Sciences (LD, JAM, EM) and Medical Imaging (CP-F), and Division of Neurology (JAM, EM), Department of Medicine, University of Toronto, Toronto, Canada
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2
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Park YB, Baek SH, Lee SU, Yu S, Kim JS. Bilateral Internuclear Ophthalmoplegia as a Manifestation of Varicella Zoster Encephalitis. J Neuroophthalmol 2023; 43:e79-e81. [PMID: 37603435 DOI: 10.1097/wno.0000000000001392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Young-Bin Park
- Department of Neurology (Y-BP, S-HB, S-UL, SY), Korea University Medical Center, Seoul, Republic of Korea; Department of Neurology (S-UL, J-SK), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurology (SY), Korea University College of Medicine, Seoul, Republic of Korea; and Dizziness Center (J-SK), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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3
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Zainal Abidin N, Tuan Jaffar TN, Ahmad Tajudin LS. Wall-Eyed Bilateral Internuclear Ophthalmoplegia as an Early Presentation of Multiple Sclerosis. Cureus 2023; 15:e36835. [PMID: 37123672 PMCID: PMC10147486 DOI: 10.7759/cureus.36835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare neuro-ophthalmological condition in which there is ocular motility impairment characterized by bilateral adduction deficiencies, bilateral abducting nystagmus, and exotropia in primary gaze, and is often associated with multiple sclerosis (MS). This report describes a young female who presented with sudden onset of binocular diplopia and alternating exotropia for two days duration, which was associated with a history of intermittent headaches for one year before presenting complaints. Examination revealed alternating exotropia on the primary gaze with bilateral limitation of adduction and bilateral nystagmus on abduction. Other ocular and neurological examinations were unremarkable. Neuroimaging showed multiple white matter lesions that were consistent with demyelinating disease. Her symptoms completely resolved after the initiation of intravenous corticosteroid therapy. However, she developed left upper limb numbness four months later, and a repeat magnetic resonance imaging (MRI) of the brain showed the presence of multiple new brain lesions. Subsequently, she was diagnosed with MS and started on immunotherapy. Her symptoms resolved, with no residual ophthalmoplegia or any neurological symptoms.
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4
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A rare case of a wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome in a patient with cutaneous lupus erythematosus after COVID-19 infection. J Neurol 2023; 270:1224-1228. [PMID: 36576573 PMCID: PMC9795426 DOI: 10.1007/s00415-022-11548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
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5
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Distinguishing CNS neurosarcoidosis from multiple sclerosis and an approach to “overlap” cases. J Neuroimmunol 2022; 369:577904. [DOI: 10.1016/j.jneuroim.2022.577904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022]
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6
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Update on the medial longitudinal fasciculus syndrome. Neurol Sci 2022; 43:3533-3540. [DOI: 10.1007/s10072-022-05967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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7
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Custo S, Tabone E, Grech R. One-and-a-half syndrome as an initial presentation of multiple sclerosis. Br J Hosp Med (Lond) 2022; 83:1-3. [PMID: 35506717 DOI: 10.12968/hmed.2021.0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Scott Custo
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Emma Tabone
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Reuben Grech
- Department of Medical Imaging, Mater Dei Hospital, Msida, Malta.,Department of Clinical Radiology and Nuclear Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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8
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Pujari A, Bhaskaran K, Modaboyina S, Das D, Saluja G, Samdani A, Singh P, Bajaj MS, Sharma N. Cysticercosis in ophthalmology. Surv Ophthalmol 2021; 67:544-569. [PMID: 34339720 DOI: 10.1016/j.survophthal.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022]
Abstract
Cysticercosis is caused by Taenia solium, a cestode or tapeworm that preferentially affects the subcutaneous tissue, brain, muscle, and the eye. It is traditionally a disease of low socioeconomic regions, but large-scale population migration has made it a matter of global concern. Its ocular invasion is a potentially blinding disease. In the last two decades, there has been considerable discussion of cysticercosis; however, most comes from a limited number of case observations. Thus, to overcome this limitation, we summarize and analyse twenty years of medical literature (from 2000 to 2020) on cysticercosis in ophthalmology.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India.
| | - Karthika Bhaskaran
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
| | - Sujeeth Modaboyina
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
| | - Deepshekhar Das
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
| | - Gunjan Saluja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
| | - Asha Samdani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
| | - Pallavi Singh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
| | - Mandeep S Bajaj
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, RPC-1, AIIMS, New Delhi, India
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9
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Abstract
BACKGROUND To describe the various neuro-ophthalmic presentations, key exam features, and clinical findings associated with 5 common primary and secondary intracranial malignancies. EVIDENCE ACQUISITION Retrospective PubMed search and review of published case reports, case series, observational studies, book chapters, and review articles examining the neuro-ophthalmic features of intracranial malignancies including primary glial neoplasms (e.g., glioblastoma multiforme), primary and secondary lymphoma, intracranial metastases, carcinomatous/lymphomatous meningitis, and intracranial germ cell tumors. The search strategy used to perform the retrospective review included the aforementioned tumor type (e.g., glioblastoma multiforme) and the following terms and Boolean operators: AND ("visual loss" OR "papilledema" OR "diplopia" OR "ophthalmoplegia" or "neuro-ophthalmology" OR "proptosis"). RESULTS The rate of growth and the location of an intracranial tumor are essential factors in determining the neuro-ophthalmic presentation of certain intracranial malignancies. Primary malignant brain glial neoplasms commonly present with visual afferent complaints (e.g., unilateral or bilateral visual acuity or visual field defects, bitemporal or homonymous hemianopsia), pupil abnormalities (relative afferent pupillary defect), and optic atrophy or papilledema. Primary intraocular lymphoma (with or without central nervous system lymphoma) typically presents as a painless bilateral vitritis. Secondary intracranial malignancies have variable afferent and efferent visual pathway presentations. Carcinomatous/lymphomatous meningitis is associated with diplopia (e.g., multiple ocular motor cranial neuropathies with or without vision loss from papilledema or compressive/infiltrative optic neuropathy). Intracranial germ cell tumors can present with a chiasmal syndrome or dorsal midbrain syndrome. CONCLUSION Intracranial malignancies can present with neuro-ophthalmic symptoms or signs depending on topographical localization. Specific neuro-ophthalmic presentations are associated with different malignant intracranial tumors. Clinicians should be aware of the common malignant intracranial tumors and their associated clinical presentations in neuro-ophthalmology.
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10
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Infectious ophthalmoplegias. J Neurol Sci 2021; 427:117504. [PMID: 34082150 DOI: 10.1016/j.jns.2021.117504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022]
Abstract
Though infections account for a significant proportion of patients with ocular motor palsies, there is surprising paucity of literature on infectious ophthalmoplegias. Almost all types of infectious agents (bacteria, viruses, fungi and parasites) can lead to ocular motor palsies. The causative infectious agent can be diagnosed in most cases using an orderly stepwise approach. In this review we discuss how to approach a patient with ophthalmoplegia with main focus on infectious etiologies.
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11
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Wu Y, Cafiero‐chin M, Marques C. Wall‐eyed bilateral internuclear ophthalmoplegia: review of pathogenesis, diagnosis, prognosis and management. Clin Exp Optom 2021; 98:25-30. [DOI: 10.1111/cxo.12200] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/19/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yu‐tai Wu
- School of Optometry, University of California, Berkeley, Berkeley, California, USA,
| | | | - Cathy Marques
- VA New Jersey Healthcare System, Lyons, New Jersey, USA,
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12
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Kleinsorge MT, Ebert A, Förster A, Weber CE, Roßmanith C, Platten M, Gass A, Eisele P. MRI topography of lesions related to internuclear ophthalmoplegia in patients with multiple sclerosis or ischemic stroke. J Neuroimaging 2021; 31:471-474. [PMID: 33793026 DOI: 10.1111/jon.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Internuclear ophthalmoplegia is a dysfunction of conjugate eye movements, caused by lesions affecting the medial longitudinal fasciculus (MLF). Multiple sclerosis (MS) and ischemic stroke represent the most common pathophysiologies. While magnetic resonance imaging (MRI) allows for localizing lesions affecting the MLF, comprehensive comparative studies exploring potential different spatial characteristics of lesions affecting the MLF are missing until now. METHODS We retrospectively investigated MRI examinations of 82 patients (40 patients with MS and 42 patients with ischemic stroke). For lesion localization, the brainstem was segmented into (1) ponto-medullary junction, (2) mid pons, (3) upper pons, and (4) mesencephalon. RESULTS Corresponding lesions affecting the MLF were observed in 29/40 (72.5%) MS and 38/42 (90.5%) stroke patients. Compared to stroke patients, MS patients had significantly more lesions in multiple locations (P < .001). Stroke patients showed more lesions at the level of the mesencephalon (P < .001), while lesions at the level of the ponto-medullary junction, mid, and upper pons did not statistically differ between the groups. CONCLUSION Our results demonstrate that multiple lesions affecting the MLF make inflammatory-demyelination due to MS more likely, while lesion localization at the level of the mesencephalon favors ischemia.
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Affiliation(s)
- Marie T Kleinsorge
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Anne Ebert
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Christina Roßmanith
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany.,Ruprecht-Karls-Universitat Heidelberg Medizinische Fakultat Mannheim (99045).,Universitatsklinikum Mannheim (36642)
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13
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Fiester P, Baig SA, Patel J, Rao D. An Anatomic, Imaging, and Clinical Review of the Medial Longitudinal Fasciculus. J Clin Imaging Sci 2021; 10:83. [PMID: 33408958 PMCID: PMC7771398 DOI: 10.25259/jcis_49_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/10/2020] [Indexed: 12/03/2022] Open
Abstract
The medial longitudinal fasciculus (MLF) is a paired, highly specialized, and heavily myelinated nerve bundle responsible for extraocular muscle movements, including the oculomotor reflex, saccadic eye movements an smooth pursuit, and the vestibular ocular reflex. Clinically, lesions of the MLF are classically associated with internuclear ophthalmoplegia. However, clinical manifestations of a lesion in the MLF may be more complex and variable. We provide an overview of the neuroanatomy, neurologic manifestations, and correlative examples of the imaging findings on brain MRI of MLF lesions to provide the clinician and radiologist with a more comprehensive understanding of the MLF and potential clinical manifestations for an MLF lesion.
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Affiliation(s)
- Peter Fiester
- Department of Neuroradiology, University of Florida Health Jacksonville, Jacksonville, Florida, United States
| | - Saif Ahmed Baig
- Department of Neuroradiology, University of Florida Health Jacksonville, Jacksonville, Florida, United States
| | - Jeet Patel
- Department of Neuroradiology, University of Florida Health Jacksonville, Jacksonville, Florida, United States
| | - Dinesh Rao
- Department of Neuroradiology, University of Florida Health Jacksonville, Jacksonville, Florida, United States
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14
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Grillini A, Renken RJ, Vrijling ACL, Heutink J, Cornelissen FW. Eye Movement Evaluation in Multiple Sclerosis and Parkinson's Disease Using a Standardized Oculomotor and Neuro-Ophthalmic Disorder Assessment (SONDA). Front Neurol 2020; 11:971. [PMID: 33013643 PMCID: PMC7506055 DOI: 10.3389/fneur.2020.00971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Evaluating the state of the oculomotor system of a patient is one of the fundamental tests done in neuro-ophthalmology. However, up to date, very few quantitative standardized tests of eye movements' quality exist, limiting this assessment to confrontational tests reliant on subjective interpretation. Furthermore, quantitative tests relying on eye movement properties, such as pursuit gain and saccade dynamics are often insufficient to capture the complexity of the underlying disorders and are often (too) long and tiring. In this study, we present SONDA (Standardized Oculomotor and Neurological Disorder Assessment): this test is based on analyzing eye tracking recorded during a short and intuitive continuous tracking task. We tested patients affected by Multiple Sclerosis (MS) and Parkinson's Disease (PD) and find that: (1) the saccadic dynamics of the main sequence alone are not sufficient to separate patients from healthy controls; (2) the combination of spatio-temporal and statistical properties of saccades and saccadic dynamics enables an identification of oculomotor abnormalities in both MS and PD patients. We conclude that SONDA constitutes a powerful screening tool that allows an in-depth evaluation of (deviant) oculomotor behavior in a few minutes of non-invasive testing.
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Affiliation(s)
- Alessandro Grillini
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Remco J Renken
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anne C L Vrijling
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, Netherlands
| | - Joost Heutink
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - Frans W Cornelissen
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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15
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Fiester P, Rao D, Soule E, Andreou S, Haymes D. The Medial Longitudinal Fasciculus and Internuclear Opthalmoparesis: There's More Than Meets the Eye. Cureus 2020; 12:e9959. [PMID: 32983663 PMCID: PMC7510542 DOI: 10.7759/cureus.9959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and purpose The classic sign of a lesion in the medial longitudinal fasciculus is internuclear opthalmoplegia. However, clinical presentation may vary depending on the type of pathology and the lesion location. The purpose of this study was to identify and classify the different lesions of the medial longitudinal fasciculus on MRI and review their clinical presentations. We also offer an overview of the pertinent imaging anatomy of the medial longitudinal fasciculus. Materials and methods Patients with an abnormality affecting the medial longitudinal fasciculus were identified retrospectively using the keyword ‘medial longitudinal fasciculus’ included in radiology reports between 2010 and 2018 using the Nuance mPower software (Nuance Communications, Burlington, MA). The brain MRI examinations of these patients were reviewed by two neuroradiolgists. Detailed description of lesion location within the medial longitudinal fasciculus, pathology type, additional lesions, and clinical presentations were recorded along with pertinent demographic information. Results Five men and four women were identified with lesions in the medial longitudinal fasciculus on brain MRI. Five patients demonstrated demyelination in the medial longitudinal fasiculus and four patients demonstrated findings of an acute cerebrovascular accident. Two-thirds of medial longitudinal fasiculus lesions were located in the upper, mid, or lower pons with the remaining located in the midbrain. Of the patients presenting with a cerebrovascular accident, there was little to no additional evidence of acute stroke elsewhere in the brain. All patients were clinically symptomatic with 89% of patients demonstrating extraocular muscle dysfunction at presentation and 78% of patients experiencing dizziness. Additional symptoms included headache, weakness, and gait instability. Conclusions Lesions involving the medial longitudinal fasiculus may not always present with the classic sign of internuclear opthalmoplegia. Variations in lesion location may result in diplopia rather than internuclear opthalmoplegia, and additional brain lesions may produce clinical symptoms that confound extraocular muscle dysfunction. Lesions affecting the often-overlooked vestibular and otolithic reflexes, which run in the medial longitudinal fasiculus, may result in dizziness/weakness and mask the classic internuclear opthalmoplegia symptoms. The radiologist should carefully inspect the medial longitudinal fasiculus in all patients regardless of the supportive clinical history of extraocular muscle dysfunction since symptoms may be more general than classically described.
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Affiliation(s)
- Peter Fiester
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Dinesh Rao
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Erik Soule
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Sonia Andreou
- Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Dalys Haymes
- Neuroradiology, University of Florida Health, Jacksonville, USA
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16
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Foreman D, Webb A, Mendez D, Ugalde I. Adolescent with headache and double vision. J Am Coll Emerg Physicians Open 2020; 1:683-684. [PMID: 33000101 PMCID: PMC7493588 DOI: 10.1002/emp2.12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- David Foreman
- McGovern Medical School at University of Texas Health Science Center at Houston (UT Health)Emergency Medicine Houston Texas USA
| | - Ashley Webb
- McGovern Medical School at University of Texas Health Science Center at Houston (UT Health)Emergency Medicine Houston Texas USA
| | - Donna Mendez
- McGovern Medical School at University of Texas Health Science Center at Houston (UT Health)Emergency Medicine Houston Texas USA
| | - Irma Ugalde
- McGovern Medical School at University of Texas Health Science Center at Houston (UT Health)Emergency Medicine Houston Texas USA
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17
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Vázquez-Justes D, Martín-Cucó A, Gallego-Sánchez Y, Vicente-Pascual M. WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia) secondary to ischemic stroke, about a case. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:205-208. [PMID: 32088083 DOI: 10.1016/j.oftal.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
WEBINO (wall-eyed bilateral internuclear ophthalmoplegia) syndrome is characterized by bilateral adduction impairment, nystagmus of the abducting eye, and primary gaze exotropia. We present the case of a 68 year-old man who was initially attended in emergency department with sudden onset diplopia. Neurological exploration revealed WEBINO and gait ataxia. Relevant medical history included liver transplantation and subsequent tacrolimus prescription. Complementary exams revealed ischemic lesion in mesencephalic tegmentum, involving medial longitudinal fasciculus and pretectal area. WEBINO syndrome is unfrequent. Among its etiologies, ischemic and demyelinating are the most frequent. In our case, iatrogenic etiology was also considered. Clinical recognition of this syndrome is required to perform adequate exams in order to reach diagnosis.
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Affiliation(s)
- D Vázquez-Justes
- Servicio de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - A Martín-Cucó
- Centro de Atención Primaria Bordeta-Magraners, Lleida, España
| | - Y Gallego-Sánchez
- Servicio de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Vicente-Pascual
- Servicio de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España.
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18
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Gil-Casas A, Piñero DP, Molina-Martin A. Binocular, Accommodative and Oculomotor Alterations In Multiple Sclerosis: A Review. Semin Ophthalmol 2020; 35:103-115. [PMID: 32228341 DOI: 10.1080/08820538.2020.1744671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis (MS) is an acquired demyelinating and inflammatory neurodegenerative disease affecting the central nervous system (CNS). Clinical and subclinical ocular disturbances occur in almost all patients with MS. The objective of this narrative review was to collect and summarize the available scientific information on oculomotor, accommodative and binocular alterations that have been reported in MS. A systematic search strategy with the following descriptors was carried out: multiple sclerosis, ocular motility disorders, internuclear ophthalmoplegia, nystagmus, vergences, fixation, pupil reflex, accommodation and stereopsis. According to the search, some oculomotor alterations were found to be commonly reported in MS, such as alterations in saccades and nystagmus. In contrast, accommodative, vergence and stereopsis alterations have not been comprehensively studied despite their relevance, with only minimal evidence showing a potential negative impact of the disease on these aspects. In conclusion, oculomotor impairment is a common component of disability in MS patients and should be considered when managing this type of patients. More research is still needed to know the real impact of this disease on binocular vision and accommodation.
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Affiliation(s)
- Amparo Gil-Casas
- Clínica Optométrica, Foundation Lluís Alcanyís, University of Valencia, Valencia, Spain
| | - David P Piñero
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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Hai S, Elkbuli A, Kinslow K, McKenney M, Boneva D. When "looks" can be deceiving - Internuclear ophthalmoplegia after mild traumatic brain injury: Case report and literature review. Int J Surg Case Rep 2019; 63:19-22. [PMID: 31539826 PMCID: PMC6796632 DOI: 10.1016/j.ijscr.2019.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/24/2019] [Indexed: 11/25/2022] Open
Abstract
We report a case of WEMINO caused by mild traumatic brain injury, presenting with typical left ocular manifestations. CT scan of brain was noncontributory, but MRI managed to delineate the site of injury in the MLF in the left temporo-occipital white matter. Although more common in demyelinating diseases, clinicians should be cognizant of this syndrome in mild TBI patients that have ocular exotropia.
Introduction Walled-eyed monocular internuclear ophthalmoplegia (WEMINO) syndrome is a sub-variant of internuclear ophthalmoplegia (INO) and involves the same clinical findings with the addition of exotropia of the ipsilateral eye. Causes typically include multiple sclerosis (MS) and ischemia (hemorrhagic or embolic) but can be secondary to blunt trauma as seen in our presented case. Presentation of case A 27-year-old man presented with new-onset visual changes, diplopia, and strabismus following a motor vehicle collision. Physical exam showed left ocular exotropia and slight hypertropia on forward gaze with deficiency of left convergence and disconjugate eye movements on horizontal gaze with right nystagmus on rightward gaze. Imaging showed hyperintensities in the right middle cerebellar peduncle and left temporal-occipital white matter likely consistent with diffuse axonal injury but otherwise nonspecific. The patient was treated conservatively with left eyepatch and exhibited improvement of exotropia and diplopia at 1 week follow up. Discussion Common causes of WEMINO syndrome include MS and ischemia with no prior reports, to our knowledge, being secondary to the blunt trauma seen in our case. Patients with WEMINO present with the typical signs of failure of ipsilateral adductive movement during lateral along with ipsilateral exotropia. Management involves treating the underlying disorder, if possible, with conservative measures with traumatic origins. Conclusion Until now, WEMINO syndrome secondary to trauma has not been previously documented. Our patient was effectively treated with conservative measures alone.
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Affiliation(s)
- Shaikh Hai
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States.
| | - Kyle Kinslow
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
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Nourbakhsh B, Cordano C, Renthal W. Determining the Etiology of Internuclear Ophthalmoplegia in a Patient with a Cardiac Pacemaker and Complex Neurological Presentation. J Clin Neurol 2018; 14:574-576. [PMID: 30198234 PMCID: PMC6172500 DOI: 10.3988/jcn.2018.14.4.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian Cordano
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - William Renthal
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Xue F, Zhang L, Zhang L, Ying Z, Sha O, Ding Y. One-and-a-half syndrome with its spectrum disorders. Quant Imaging Med Surg 2017; 7:691-697. [PMID: 29312874 DOI: 10.21037/qims.2017.12.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One-and-a-half syndrome is a syndrome characterized by horizontal movement disorders of the eyeballs, which was first reported and named by Fisher in 1967. It presents a combination of ipsilateral conjugate horizontal gaze palsy (one) and ipsilateral internuclear ophthalmoplegia (INO) (a half). On the basis of the one-and-a-half syndrome, there are a series of related rare syndromes called the one-and-a-half syndrome spectrum disorders. This article reviews rare cases of one-and-a-half syndrome spectrum disorder, describes the clinical and pathological features of different syndromes, and summarizes their nomenclature.
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Affiliation(s)
- Fang Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Lihong Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Li Zhang
- Department of Physiology and Neurology, University of Connecticut, Storrs, USA
| | - Zhenguang Ying
- Department of Anatomy, Histology and Developmental Biology, School of Basic Medical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Ou Sha
- Department of Anatomy, Histology and Developmental Biology, School of Basic Medical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Abstract
BACKGROUND Multiple sclerosis (MS) is a demyelinating disease of the central nervous system leading to disability, especially in young patients. Acute or chronic lesions of MS within the brainstem and the cerebellum frequently result in ocular motor disorders. EVIDENCE ACQUISITION This review encompasses the spectrum of ocular motor disorders in patients with MS emphasizing prevalence, examination findings, diagnostic features, functional consequences, classification of MS course, and management of these disturbances of ocular motility. RESULTS Ocular motor manifestations of MS can occur acutely in relapse or chronically, the latter as a consequence of previous relapses or as a chronic course of the disease. The most frequent and specific acute ocular motor manifestation is uni- or bilateral internuclear ophthalmoplegia (INO). The most frequent chronic manifestations include INO and cerebellar ocular motor disorders such as gaze-evoked nystagmus, saccadic hypermetria, and lack of vestibulo-ocular reflex inhibition. The most disabling syndrome is pendular nystagmus. CONCLUSIONS The high prevalence of ocular motor manifestations emphasizes the importance of neuro-ophthalmological examination among patients with MS. Because chronic manifestations may cause minimal or no symptoms, a systematic investigation of the most common manifestations should be performed in daily practice. Appropriate treatment may improve visual outcome in some of these ocular motor disorders.
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Natsis KS, Boura E, Kyriazis O, Iliadis A, Syntila SA, Kostopoulos I, Afrantou T. Bilateral Internuclear Ophthalmoplegia as a Presenting Manifestation of Primary Sjögren's Syndrome. Neuroophthalmology 2016; 40:247-250. [PMID: 27928415 DOI: 10.1080/01658107.2016.1218519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022] Open
Abstract
Bilateral internuclear ophthalmoplegia has been linked with various pathological conditions of the central nervous system (CNS), such as multiple sclerosis, stroke, tumours, and brainstem inflammatory processes. Herein the authors report a case of a 45-year-old female patient who presented with diplopia due to bilateral internuclear ophthalmoplegia, with no evidence of brainstem lesion in brain magnetic resonance imaging (MRI) and was diagnosed with primary Sjögren's syndrome.
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Affiliation(s)
- K S Natsis
- Second Department of Neurology, Aristotle University of Thessaloniki AHEPA Hospital , Thessaloniki, Greece
| | - E Boura
- Second Department of Neurology, Aristotle University of Thessaloniki AHEPA Hospital , Thessaloniki, Greece
| | - O Kyriazis
- Third Department of Psychiatry, Aristotle University of Thessaloniki AHEPA Hospital , Thessaloniki, Greece
| | - A Iliadis
- Department of Pathology, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - S-A Syntila
- Second Department of Neurology, Aristotle University of Thessaloniki AHEPA Hospital , Thessaloniki, Greece
| | - I Kostopoulos
- Department of Pathology, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - T Afrantou
- Second Department of Neurology, Aristotle University of Thessaloniki AHEPA Hospital , Thessaloniki, Greece
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Affiliation(s)
- Julie Vadboncoeur
- Resident in Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Katarzyna Biernacki
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Alexandre Prat
- Department of Neurology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Laurence Jaworski
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
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McNulty JP, Lonergan R, Bannigan J, O’Laoide R, Rainford LA, Tubridy N. Visualisation of the medial longitudinal fasciculus using fibre tractography in multiple sclerosis patients with internuclear ophthalmoplegia. Ir J Med Sci 2016; 185:393-402. [DOI: 10.1007/s11845-016-1405-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
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Johkura K, Kudo Y, Amano Y, Kikyo H, Imazeki R, Amari K, Yamamoto M. Gaze palsy and exotropia in internuclear ophthalmoplegia. J Neurol Sci 2015; 353:158-60. [PMID: 25911021 DOI: 10.1016/j.jns.2015.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 03/19/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Unilateral gaze palsy associated with internuclear ophthalmoplegia (INO), i.e., one-and-a-half syndrome, is well known. Exotropia can also be associated with INO, but it has been reported only rarely. We sought to determine the frequencies and courses of gaze palsy and exotropia in INO. METHODS Patients hospitalized with acute-onset INO during the period January 2009 through December 2013 were identified from our clinical registry. Associated gaze palsy and exotropia were evaluated in the identified patients. RESULTS Twenty-five patients with unilateral INO and 7 patients with bilateral INO were included in this study. Of the 25 patients with unilateral INO, 4 (16.0.0%) had ipsilateral gaze palsy (one-and-a-half syndrome), 8 (32.0%) had exotropia (non-paralytic pontine exotropia), and 6 (24.0%) had both ipsilateral gaze palsy and exotropia (paralytic pontine exotropia). Six (85.7%) of the 7 patients with bilateral INO had exotropia. The gaze palsy persisted more than 1 week in 40.0% of patients, whereas the exotropia disappeared within 1 week in 92.9% of patients when the INO was unilateral. CONCLUSION Exotropia is not uncommon in the acute stage of INO. However, it is often overlooked because of its short duration.
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Affiliation(s)
- Ken Johkura
- Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan; Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan.
| | - Yosuke Kudo
- Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan; Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Yu Amano
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Hideyuki Kikyo
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Ryoko Imazeki
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Kazumitsu Amari
- Department of Neuroendovascular Therapy, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Masahiro Yamamoto
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
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Mazurkiewicz-Bełdzińska M, Szmuda M, Zawadzka M. Internuclear opthalmoplegia as a symptom of ischemic stroke in a girl with patent foramen ovale. Pediatr Neurol 2015; 52:466-7. [PMID: 25682482 DOI: 10.1016/j.pediatrneurol.2014.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | - Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Zawadzka
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
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Unilateral Internuclear Ophthalmoplegia as an Isolated Presentation of Metastatic Melanoma. J Neuroophthalmol 2015; 35:54-6. [DOI: 10.1097/wno.0000000000000171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gelaw Y. Cogan’s anterior internuclear ophthalmoplegia in young Ethiopian: A case report and review of literature. ALEXANDRIA JOURNAL OF MEDICINE 2014. [DOI: 10.1016/j.ajme.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yeshigeta Gelaw
- Department of Ophthalmology, College of Public Health and Medical Sciences , Jimma University , Jimma, Ethiopia
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Torres-Torres R, Sanchez-Dalmau BF. Treatment of acute optic neuritis and vision complaints in multiple sclerosis. Curr Treat Options Neurol 2014; 17:328. [PMID: 25399875 DOI: 10.1007/s11940-014-0328-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OPINION STATEMENT Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system, in which almost all patients develop some degree of visual impairment during the disease. Optic neuritis is the most common and known visual affection and may be the initial clinical disease manifestation, but visual complaints can have a wide variety of presentations and some of them can lead to clinical confusion. Most symptoms are the result of acute injury and subsequent axonal loss in the afferent and efferent visual pathway, but others may be consequences of treatments. Currently, we can tell the functional and anatomical damage caused by multiple sclerosis by visual function test, measurement of eye movements, electrophysiological testing, optical coherence tomography, and magnetic resonance imaging. The purpose of this review is to describe the afferent and efferent visual symptoms associated with multiple sclerosis or multiple sclerosis treatment, and review the current and future therapeutic options available for them.
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Affiliation(s)
- Ruben Torres-Torres
- Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic. Seu Maternitat, Sabino d'Arana (s/n), 08028, Barcelona, Spain
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McNulty JP, Lonergan R, Brennan PC, Evanoff MG, O'Laoide R, Ryan JT, Tubridy N. Diagnostic Efficacy of Conventional MRI Pulse Sequences in the Detection of Lesions Causing Internuclear Ophthalmoplegia in Multiple Sclerosis Patients. Clin Neuroradiol 2014; 25:233-9. [PMID: 24599322 DOI: 10.1007/s00062-014-0295-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/01/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the diagnostic efficacy of a range of conventional magnetic resonance imaging (MRI) pulse sequences in the identification of internuclear ophthalmoplegia (INO) caused by medial longitudinal fasciculus (MLF) lesions in multiple sclerosis patients using a receiver-operating characteristic (ROC) methodology. METHODS A total of 15 clinically confirmed INO and 15 control subjects underwent conventional MRI at 1.5 T consisting of T2-weighted, proton density (PD)-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences, following full institutional approval. A free-response, multiple-reader multiple-case design ROC study was used to evaluate the diagnostic efficacy of each sequence. All imaging sequences were evaluated by 10 board-certified neuroradiologists. Area under the curve (AUC), sensitivity, and specificity were analysed statistically for all three pulse sequences using repeated-measures analyses of variance and post-test analysis using Bonferroni's multiple comparison test of differences. RESULTS No significant AUC differences were found between the three sequences (p = 0.0697), with T2 recording the highest AUC (0.8346). Sensitivity differences between PD (0.7927) and FLAIR (0.6329) were significant (p < 0.05). Non-significant differences were also evident between T2 and FLAIR (p = 0.0511). The specificity analysis revealed an overall difference (p = 0.0005), with specific inter-sequence differences shown between T2 and PD (p < 0.05) and PD and FLAIR (p < 0.001) with the PD values being lower than those provided with the other two sequences. CONCLUSION T2-weighted axial imaging through the MLF region resulted in the greatest overall diagnostic efficacy when viewing a combination of mean AUC, sensitivity, and specificity, in terms of the identification of INO-causing lesions.
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Affiliation(s)
- J P McNulty
- School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland,
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Abstract
BACKGROUND Internuclear ophthalmoplegia (INO) is a rare eye movement disorder in the pediatric population. METHODS We performed a retrospective review at a university-based tertiary referral ophthalmology practice from 2004 to 2012 to identify pediatric patients with INO. RESULTS Three patients with INO were identified. Etiologies included high-grade astrocytoma, perinantal hypoxia and neonatal intracerebral hemorrhage. One of our patients, a 2 year-old girl, is the youngest reported case of INO. CONCLUSION While rare, INO in a pediatric patient requires a full neurologic evaluation and careful follow-up to assess eye position and potentially treat amblyopia.
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Abstract
Multiple sclerosis has several ophthalmic manifestations, including optic neuritis, internuclear ophthalmoplegia, and nystagmus. The presentation, treatment, and prognosis of visual complaints secondary to multiple sclerosis are discussed. Additionally, the use of optical coherence tomography and complications related to the use of fingolimod are considered.
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Affiliation(s)
- Courtney E Francis
- Department of Ophthalmology, University of Washington, Box 359608, 325 9th Avenue, Seattle, WA 98104-2499, USA.
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Rismanchi N, Crawford JR. Bilateral internuclear ophthalmoplegia associated with pediatric brain tumor progression: a case series and review of the literature. J Neurooncol 2013; 115:487-91. [PMID: 24048548 DOI: 10.1007/s11060-013-1250-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
Abstract
Internuclear ophthalmoplegia (INO) is a rare disorder of conjugate lateral gaze that has been described in a number of neurologic conditions including multiple sclerosis, stroke and less commonly brain tumors. We describe a series of 3 boys (11, 12, 15 years) diagnosed with primary central nervous system tumors (pilomyxoid variant astrocytoma, anaplastic oligoastrocytoma, gliomatosis cerebri) who developed bilateral INO as a manifestation of progressive disease. Time from diagnosis to development of bilateral INO ranged from 13-36 months. All children died of their disease 1-9 months following diagnosis of bilateral INO and had significant dorsal pontine invasion on magnetic resonance imaging at progression. Only one child had brainstem involvement at diagnosis. Our case series highlights this rare ophthalmologic syndrome of bilateral INO in association with tumor progression and provides a literature review of brain tumor associations with INO.
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Affiliation(s)
- Neggy Rismanchi
- Division of Child Neurology, Department of Neurosciences, University of California San Diego, Rady Children's Hospital, 8010 Frost Street Suite 400, San Diego, CA, 92123, USA,
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Su CH, Young YH. Clinical significance of pathological eye movements in diagnosing posterior fossa stroke. Acta Otolaryngol 2013; 133:916-23. [PMID: 23944944 DOI: 10.3109/00016489.2013.783716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Close observation of pathological eye movements such as disconjugate eye movements, multi-directional gaze nystagmus, and persistent unilateral gaze nystagmus may facilitate the effort of clinicians to arrange magnetic resonance imaging (MRI) study, because physical examinations may overlook the posterior fossa lesions. OBJECTIVE This paper reviews our experience of patients with posterior fossa stroke via observation of pathological eye movements over the past 10 years. METHODS Seventy patients with posterior fossa stroke manifested as acute vertiginous attack were admitted. All patients underwent examination of eye movements, MRI, and a battery of audiovestibular function tests. RESULTS Of the 70 patients, 22 (31%) demonstrated pathological eye movements including persistent (>24 h) unilateral gaze nystagmus in 12 patients, and multi-directional gaze nystagmus in 10 patients. Conjugate eyes movements were identified in 18 patients, and disconjugate eye movements were shown in 4 patients including medial longitudinal fasciculus syndrome in 1, paramedian pontine reticular formation syndrome in 1, and one and a half syndrome in 2. The vestibular test battery revealed abnormal responses for >85% of the patients in each test. MRI demonstrated infarction or hemorrhage involving the brainstem in 12 patients, cerebellum in 8 patients, and both in 2 patients.
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Affiliation(s)
- Chia-Hung Su
- Department of Otolaryngology, Catholic Cardinal Tien Hospital, Fu-Jen Catholic University , Taipei
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Del Brutto OH, Del Brutto VJ. Isolated brainstem cysticercosis: A review. Clin Neurol Neurosurg 2013; 115:507-11. [DOI: 10.1016/j.clineuro.2012.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/13/2012] [Accepted: 12/22/2012] [Indexed: 10/27/2022]
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Abstract
PURPOSE OF REVIEW To review the various efferent visual system disorders associated with multiple sclerosis (MS). RECENT FINDINGS Studies have supported the use of internuclear ophthalmoplegia, a model to study effects of fatigue and heat in MS patients. SUMMARY There are a host of efferent ocular manifestations that can present throughout the course of MS. These may manifest as blurred vision, potentially misleading both the patient and clinician to suspect an afferent visual deficit. Other efferent symptoms include diplopia, oscillopsia, and vertigo. The efferent system can be divided into broad categories: supranuclear, internuclear, nuclear, and gaze-holding systems. This review will briefly touch on the anatomy as well as the signs and symptoms associated with MS-related dysfunction involving these systems.
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Jasse L, Vukusic S, Durand-Dubief F, Vartin C, Piras C, Bernard M, Pélisson D, Confavreux C, Vighetto A, Tilikete C. Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability. Mult Scler 2013; 19:1618-26. [DOI: 10.1177/1352458513479840] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to evaluate in multiple sclerosis (MS) patients the prevalence of persistent complaints of visual disturbances and the mechanisms and resulting functional disability of persistent visual complaints (PVCs). Methods: Firstly, the prevalence of PVCs was calculated in 303 MS patients. MS-related data of patients with or without PVCs were compared. Secondly, 70 patients with PVCs performed an extensive neuro-ophthalmologic assessment and a vision-related quality of life questionnaire, the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25). Results: PVCs were reported in 105 MS patients (34.6%). Patients with PVCs had more frequently primary progressive MS (30.5% vs 13.6%) and more neuro-ophthalmologic relapses (1.97 vs 1.36) than patients without PVCs. In the mechanisms/disability study, an afferent visual and an ocular-motor pathways dysfunction were respectively diagnosed in 41 and 59 patients, mostly related to bilateral optic neuropathy and bilateral internuclear ophthalmoplegia. The NEI-VFQ 25 score was poor and significantly correlated with the number of impaired neuro-ophthalmologic tests. Conclusion: Our study emphasizes the high prevalence of PVC in MS patients. Regarding the nature of neuro-ophthalmologic deficit, our results suggest that persistent optic neuropathy, as part of the progressive evolution of the disease, is not rare. We also demonstrate that isolated ocular motor dysfunctions induce visual disability in daily life.
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Affiliation(s)
- Laurence Jasse
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
| | - Sandra Vukusic
- University Lyon, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-oncology and Neuro-inflammation Team, France
| | - Françoise Durand-Dubief
- Neurology A and EDMUS Coordinating Center for Multiple Sclerosis, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, University Lyon1, France
| | - Cristina Vartin
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Carolina Piras
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Martine Bernard
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Denis Pélisson
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
| | - Christian Confavreux
- University Lyon, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-oncology and Neuro-inflammation Team, France
| | - Alain Vighetto
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Caroline Tilikete
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
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Mesraoua B, Deleu D, D'souza A, Imam YZB, Melikyan G. Neurocysticercosis presenting as a vertical one-and-a-half syndrome with associated contralesional horizontal gaze paresis. J Neurol Sci 2012; 323:250-3. [DOI: 10.1016/j.jns.2012.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/26/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
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Abstract
Multiple sclerosis (MS) is a disease marked by focal demyelinating inflammatory plaques throughout the CNS. Neuro-ophthalmologic sequelae are common in MS and may arise from the disease itself or from treatment of the disease. Both afferent and efferent functions may be affected. Despite much progress, our understanding of the pathophysiology of MS, and the efficacy of our available treatments, remain inadequate. Here, we review the chief neuro-ophthalmologic abnormalities associated with MS and discuss the emerging diagnostic and therapeutic advances that are likely to further our understanding of MS and its treatment.
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Affiliation(s)
- Ryan D Walsh
- Departments of Neurology & Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 3 W Gates Building, Philadelphia, PA 19104, USA
| | - Collin M McClelland
- Departments of Neurology & Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 3 W Gates Building, Philadelphia, PA 19104, USA
| | - Steven L Galetta
- Departments of Neurology & Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 3 W Gates Building, Philadelphia, PA 19104, USA
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Tilikete C, Jasse L, Vukusic S, Durand-Dubief F, Vardanian C, Pélisson D, Vighetto A. Persistent ocular motor manifestations and related visual consequences in multiple sclerosis. Ann N Y Acad Sci 2011; 1233:327-34. [DOI: 10.1111/j.1749-6632.2011.06116.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Graves J, Balcer LJ. Eye disorders in patients with multiple sclerosis: natural history and management. Clin Ophthalmol 2010; 4:1409-22. [PMID: 21188152 PMCID: PMC3000766 DOI: 10.2147/opth.s6383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system and leading cause of disability in young adults. Vision impairment is a common component of disability for this population of patients. Injury to the optic nerve, brainstem, and cerebellum leads to characteristic syndromes affecting both the afferent and efferent visual pathways. The objective of this review is to summarize the spectrum of eye disorders in patients with MS, their natural history, and current strategies for diagnosis and management. We emphasize the most common disorders including optic neuritis and internuclear ophthalmoparesis and include new techniques, such as optical coherence tomography, which promise to better our understanding of MS and its effects on the visual system.
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Affiliation(s)
- Jennifer Graves
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Frohman TC, Graves J, Balcer LJ, Galetta SL, Frohman EM. THE NEURO-OPHTHALMOLOGY OF MULTIPLE SCLEROSIS. Continuum (Minneap Minn) 2010; 16:122-46. [DOI: 10.1212/01.con.0000389938.07532.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Karatas M. Internuclear and supranuclear disorders of eye movements: clinical features and causes. Eur J Neurol 2009; 16:1265-77. [PMID: 19723293 DOI: 10.1111/j.1468-1331.2009.02779.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eye movements bring visual stimuli to the fovea and also maintain foveal fixation on a moving target and during head movements. These movements are performed by the ocular motor system that consists of ocular motor nerves and nuclei in the brainstem originating in the cerebral cortex, cerebellum, vestibular structures, and the extraocular muscles. The ocular motor system is divided according to anatomic location into infranuclear, nuclear, internuclear, and supranuclear components. It is important to distinguish supranuclear and internuclear from nuclear and infranuclear disturbances affecting cranial nerves III, IV, and VI, because the disturbances are of highly varied causes and present different clinical pictures. Internuclear ophthalmoplegia is due to a lesion of the medial longitudinal fasciculus, caused by multiple sclerosis in younger patients, particularly when the ophthalmoplegia is bilateral, and usually of vascular origin in the elderly. Eye movement abnormalities of supranuclear origin are characterized by gaze palsies, tonic gaze deviation, saccadic and smooth pursuit disorders, vergence abnormalities, nystagmus, and ocular oscillations. Supranuclear disorders result from lesions above the level of the ocular motor nerve nuclei. If oculocephalic maneuvers move the eyes appropriately, the lesion causing the gaze palsy is supranuclear. Supranuclear disorders account for almost 10% of all patients with disorders of eye movements.
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Affiliation(s)
- M Karatas
- Department of Neurology, Baskent University, Medical School, Adana Research Center, Adana, Turkey.
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Abstract
Multiple sclerosis is the most common disabling neurological disease in young people. Many neuro-ophthalmological manifestations can occur during the course of the illness, and optic neuritis is both the most frequent and the best known. However, some ocular motility disorders can also occur, but since there may be no symptoms, they often remain underdiagnosed. These eye movement disorders are mostly related to brain-stem and cerebellum lesions. They can be acute, indicating a spatial dissemination of the demyelinating disease, and consequently may indicate the need for systemic treatment of multiple sclerosis. More often, they evolve slowly, progressing with the multiple sclerosis. In this case, they could provide a clue to the prognosis of the disease. In this survey, we discuss the two major symptoms of ocular motor disorders likely to occur during multiple sclerosis: oscillopsia and diplopia.
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Strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis. J AAPOS 2009; 13:13-5. [PMID: 19084443 PMCID: PMC2679866 DOI: 10.1016/j.jaapos.2008.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 07/30/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Internuclear ophthalmoplegia (INO) is a disabling condition affecting up to 40% of patients with multiple sclerosis (MS). Management of bilateral internuclear ophthalmoplegia (BINO) with exotropia in MS has been controversial because of the uncertain course of MS. Diplopia associated with INO severely impacts the patient's quality of life and, therefore, treatment should be considered. METHODS Three patients (ages 28, 62, and 82 years) who had BINO with exotropia and disabling diplopia secondary to MS underwent bilateral medial rectus resections with either unilateral or bilateral adjustable lateral rectus recession(s). Alignment was measured preoperatively and postoperatively, and symptoms were recorded. RESULTS Preoperative exotropia ranged from 40(Delta) to 64(Delta) for distance fixation and from 50(Delta) to 70(Delta) for near fixation. Preoperatively, all patients had diplopia at distance and near fixation. Immediately after surgery, patients were adjusted to 10(Delta) to 18(Delta) ET at distance fixation with the expectation of an exotropic drift. None of the patients had a tropia at distance and near fixation 6 months after surgery, with single vision in primary position and reading. Two patients had a 2-year follow-up examination; 1 required a small amount of base-in prism for comfortable reading. CONCLUSIONS Three patients who had BINO with exotropia secondary to MS all benefited from surgery. Surgery should be considered as an option for symptomatic patients who have BINO with exotropia caused by MS.
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Durnian JM, Jazayeri F, Trimble V, Marsh IB. Surgical Treatment of Internuclear Ophthalmoplegia and its Variants. Neuroophthalmology 2009. [DOI: 10.1080/01658100902930511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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