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Neurocysticercosis presenting as isolated wall-eyed monocular internuclear ophthalmoplegia with contraversive ocular tilt reaction.

ABSTRACT: Neurocysticercosis is a common tropical infection presenting with neurological signs. It commonly presents as seizures but various other focal neurological presentations have been reported. Though neurocysticercosis have been reported to present as isolated internuclear ophthalmoplegia, we report the first case of neurocysticercosis presenting as wall-eyed monoocular internuclear ophthalmoplegia syndrome with contraversive ocular tilt reaction.

SUBMITTER: Chandran SR

PROVIDER: S-EPMC3271629 | biostudies-literature | 2012 Jan

REPOSITORIES: biostudies-literature

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Neurocysticercosis presenting as isolated wall-eyed monocular internuclear ophthalmoplegia with contraversive ocular tilt reaction.

Chandran Suresh R SR Balakrishnan Rojith K RK Umakanthan K K Govindarajan K K

Journal of neurosciences in rural practice 20120101 1

Neurocysticercosis is a common tropical infection presenting with neurological signs. It commonly presents as seizures but various other focal neurological presentations have been reported. Though neurocysticercosis have been reported to present as isolated internuclear ophthalmoplegia, we report the first case of neurocysticercosis presenting as wall-eyed monoocular internuclear ophthalmoplegia syndrome with contraversive ocular tilt reaction. ...[more]

PMID: 22346205

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Wall-Eyed Monocular Internuclear Ophthalmoplegia (WEMINO) and Millard-Gubler Syndromes in a Patient with Isolated Pontine Infarction: Topographic, Oculomotor, and Radiological Analysis of Two Very Uncommon Conditions.

Project description:The syndromes of wall-eyed monocular internuclear ophthalmoplegia and Millard-Gubler are very rare clinical complexes commonly caused by pontine infarction, hemorrhage, or tumors that compromise the paramedian tegmentum, medial longitudinal fascicle, and the basis pontis. We present the case of a 58-year-old female with an isolated pontine infarction characterized by acute vertigo, sudden horizontal diplopia due to ipsilateral internuclear ophthalmoplegia with exotropia, facial palsy and contralateral hemiparesis. This report analyzes, theorizes, and emphasizes the correlation between these atypical neurological findings, the pontine anatomy, and magnetic resonance imaging; encouraging the clinician to make expeditious diagnoses using the bedside skills and a high-quality oculomotor clinical examination. The phenotype and simultaneity of both syndromes makes this case a didactic exercise for the topo-diagnosis based on the neurology of eye movements, the intrinsic physiology of the pons, and the pathways that emerge or project towards it.

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Internuclear Ophthalmoplegia Secondary to Cocaine Abuse.

Project description:Purpose. To report a case of internuclear ophthalmoplegia (INO) caused by cocaine. Method. We report a case of a 54-year-old female who presented with a left INO three days after snorting cocaine, and we review the literature. Results. MRI of the brain demonstrated several small abnormal foci in the pons on FLAIR and diffusion weighted imaging consistent with ischemic infarction. The patient's symptoms remained stable throughout her hospitalization. She was sent to a rehabilitation facility and was lost to follow-up. Conclusion. In cases of extraocular movement abnormalities, it is important to inquire about recreational drug use.

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Bilateral pseudo-internuclear ophthalmoplegia in a patient with myasthenia gravis.

Project description:PurposeTo report a case of myasthenia gravis presenting with a false localizing sign, a bilateral pseudo internuclear ophthalmoplegia.ObservationsA 61 year-old male presented with a five-week history of painless binocular oblique diplopia that was associated with fatigue, vocal hoarseness and bilateral ptosis, the latter two of which worsened through the course of the day. Exam was remarkable for an apparent bilateral internuclear ophthalmoplegia (INO). MRI of the brain with and without contrast and MRA of the head and neck were within normal limits. Lab work was positive for anti-AChR binding, blocking, and modulating antibodies, as well as anti-striated muscle and anti-titin antibodies. The patient was initiated on therapy for myasthenia gravis.Conclusion and importanceAlthough myasthenia gravis often presents with ptosis or diplopia, rarely patients may develop pseudo-INO secondary to extraocular muscle weakness. True INO occurs with damage to the medial longitudinal fasciculus, a myelinated tract of fibers that controls yoked horizontal eye movements. Clinicians should be suspicious of the false localizing sign of a pseudo-INO associated with myasthenia gravis when more common causes of INO have been excluded.

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Project description:The pathologic involvement of brainstem and midbrain nuclei and white matter tracts in various combinations may result in a spectrum of arithmetically derived syndromes. They include 'one and a half syndrome', 'eight and a half syndrome' and 'fifteen and a half syndrome'. We report a case of 'nine syndrome', which has been reported more recently, caused by caused by acute pontine infarcts and characterised clinically by a combination of internuclear ophthalmolplegia, ipsilateral horizontal gaze palsy, lower motor neuron type of facial palsy, contralateral hemiparesis and hemianesthesia. We highlight the genesis of this combination of clinical signs, revisit the different variants of INO and review the literature on 'Nine syndrome'.

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The Clue is in the Eyes. A Case Report of Internuclear Ophthalmoplegia.

Project description:The chief complaint of vertiginous symptoms can be daunting, and the differential is quite long. Approximately 15% of patients presenting to the emergency department (ED) with dizziness have a dangerous underlying cause.1 We present a case of a 40-year-old female with a sudden onset of what she describes as vertigo, in the setting of intermittent diplopia. The patient was found to have a left medial rectus palsy consistent with a left internuclear ophthalmoplegia. Internuclear ophthalmoplegia (INO) is an abnormal gaze that is characterized by the weakness or inability to adduct the affected eye. This occurs secondary to a lesion in the brain affecting the medial longitudinal fasciculus (MLF) most commonly in the pons; however, this pathway can also be affected in the midbrain.2 The diagnosis in our patient was confirmed after an MRI revealed an acute infarct of the left dorsal pons involving the medial longitudinal fasciculus, resulting in the observed left INO. The patient was admitted to the hospitalist service with neurology consultation for further stroke workup. Ultimately, the stroke was deemed cryptogenic in etiology with hyperlipidemia and obesity as the patient's risk factors. She was discharged home after three days in the hospital on daily aspirin and high-intensity statin. Upon six-month follow up she had near resolution of her symptoms.TopicsInternuclear Ophthalmoplegia, INO, Vertigo, Stroke, Neurology.

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A model for interrogating the clinico-radiological paradox in multiple sclerosis: Internuclear ophthalmoplegia.

Project description:Background and purposeThe clinico-radiological paradox in multiple sclerosis (MS) is well recognized, relevant and yet poorly understood. The suitability of an in vivo model for the clinico-radiological paradox was tested, using internuclear ophthalmoplegia (INO) and the medial longitudinal fasciculus (MLF).MethodsIn this cross-sectional study lesions of the MLF were rated by an experienced MS neuroradiologist blinded to all other information. The presence of an INO was objectively determined by a validated infrared oculography protocol (DEMoNS). Clinical information, including the National Eye Institute Visual Function Questionnaire, was obtained.ResultsThis study included 202 patients with MS. The clinico-radiological paradox occurred in 50 patients (25%). This consisted of 45 patients having an INO without an MLF lesion and five patients with an MLF lesion but without an INO. The visual function overall score was related to the presence of an INO (p = 0.016), but not to MLF lesions seen on magnetic resonance imaging (MRI) (p = 0.207). A consensus list of potential causes for the clinico-radiological paradox was compiled and the MRI images were deposited in a repository.ConclusionThis study provides an objective and quantitative model to investigate the clinico-radiological paradox. Our data suggest that pathology of the MLF is more frequently detected and more clinically relevant by infrared oculography than by MLF lesion rating on MRI.

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Contraversive Ocular Tilt Reaction with Contralesional Pseudo-Abducens Palsy in a Patient with Thalamomesencephalic Stroke.

Project description:We report a patient presenting with unique neuroophthalmological features of contraversive ocular tilt reaction and concomitant contralesional pseudo-abducens palsy. Magnetic resonance imaging confirmed the presence of an acute infarct in the right thalamomesencephalic region. We discuss the clinical topography of these unique neuroophthalmological findings.

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Myasthenia Gravis With Reversible Pyramidal Tract Damage and Pseudo Internuclear Ophthalmoplegia. A Case Report and Literature Review.

Project description:Myasthenia gravis (MG) is a rare and treatable antibody-mediated autoimmune disease. Pseudo internuclear ophthalmoplegia (-INO) or pyramidal tract damage is rarely observed in MG, and there were no known cases of MG with both pseudo-INO and pyramidal tract damage. Here, we report a case of a 61-year-old female suffering from MG accompanied by pseudo-INO and pyramidal tract damage with a rapid progressive course. Her blood and cerebrospinal fluid (CSF) tests were normal, except for the presence of the anti-acetylcholine receptor antibody. CT and contrast enhancement of the chest showed a thymic involution. MRI and contrast enhancement images of the brain and whole spine were normal. Both the clinical response to the administration of neostigmine and the repetitive nerve stimulation test were positive. The motor evoked potentials at lower limb recordings were normal. According to her signs, symptoms, decrementing response on repetitive stimulation test, elevated anti-acetylcholine receptor antibody and positive response to neostigmine, the patient was diagnosed as having MG. After treatment with pyridostigmine, intravenous immunoglobulin, prednisone acetate tablets and methotrexate, all her symptoms disappeared, including pseudo-INO and pyramidal tract damage. To our best knowledge, this is the first report of a case of MG with both pseudo-INO and pyramidal tract damage. Based on our case and a review of the literature, we propose that pyramidal tract damage and pseudo-INO can be two signs of MG, and that MG can cause damage to other systems besides neuromuscular junctions.

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