Internuclear ophthalmoplegia: causes and long-term follow-up in 65 patients

Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia

A 21-year-old woman presented to the emergency department 1 day after a fall. On the day of presentation, she awoke with horizontal diplopia and posterior neck pain. Based on clinical findings, she was diagnosed with bilateral internuclear ophthalmoplegia. A conventional angiogram identified a left vertebral artery dissection. She was started on anticoagulant therapy, with gradual improvement of her diplopia over several months. Diplopia is frequently seen in the emergency department. Internuclear ophthalmoplegia is a cause of binocular diplopia and is important to recognize because it indicates a brainstem lesion requiring neurologic evaluation.

Atypical ophthalmological presentation of neurocysticercosis in two children

Cysticercosis is an infestation by Cysticercus cellulosae, the larval form of the cestode Taenia solium. C. cellulosae is preferentially encysted in the brain, striated muscles, and subcutaneous tissue. Seizures, hydrocephalus, meningitis, and focal symptoms caused by large cysts are the principal manifestations. Neuroophthalmologic signs are common with the meningitic and hydrocephalic manifestations of the disease. The first ophthalmologic clues of cysticercosis are typically papilloedema, pupillary abnormalities, or nystagmus. We report an atypical presentation of neurocysticercosis in two patients, with chief complaints of vertical diplopia and nystagmus.

Isolated Bilateral Internuclear Ophthalmoplegia After Ischemic Stroke

A 63-year-old man suddenly developed an isolated bilateral internuclear ophthalmoplegia (INO). High-resolution brain MRI showed signal abnormalities consistent with acute ischemic stroke limited to the infra-aqueductal region of the midbrain bilaterally. This case offers graphic evidence that stroke can be responsible for an isolated bilateral INO.

Ocular manifestations of multiple sclerosis

PURPOSE OF REVIEW

Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system that is commonly manifested by visual system involvement and that may initially present with ophthalmologic symptoms. This paper reviews recent findings regarding the ocular manifestations in multiple sclerosis.

RECENT FINDINGS

Manifestations of multiple sclerosis in the eye include both the afferent and efferent visual pathways. Optic neuritis, the most common ocular manifestation of multiple sclerosis, may be the initial clinical disease manifestation. Recent long-term follow-up data show that most patients with demyelinating optic neuritis have an excellent prognosis for recovery of central visual acuity. Evidence is emerging, however, for significant and broad reduction in both contrast sensitivity and color perception in multiple sclerosis patients despite near-normal visual acuities. Ocular motor deficits in multiple sclerosis include internuclear ophthalmoplegia and nystagmus, resulting in diplopia, oscillopsia, blurred visual, loss of stereopsis, and reading fatigue. Multiple sclerosis also may be associated with ocular inflammatory diseases, in particular pars planitis and retinal periphlebitis.

SUMMARY

Ocular findings may be initial manifestations of multiple sclerosis and may predict additional demyelinating events. Recognizing these syndromes and signs will help clinicians to properly evaluate the patient, formulate an appropriate differential diagnosis, be able to discuss the prognosis with the patient, and help develop an effective therapeutic plan.