Bilateral Internuclear Ophthalmoplegia in a Young Woman with Vertebral Artery Dissection

Authors

• Omar Cárdenas Neurology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
• Enrique Gomez Neurology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
• Mariana Marcín Neurology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
• Adib Jorge de Sarachaga Neurology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
• Verónica Sánchez Neurology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
• Juan Manuel Calleja Neurology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico

omarcs_2128@hotmail.com

Keywords

Abstract

Background: Internuclear ophthalmoplegia (INO) is an eye movement disorder caused by a lesion in the medial longitudinal fasciculus (MLF) located in the midbrain. Adduction paralysis of both eyes and bilateral abduction nystagmus are the main features of INO^[1].
Case presentation: A 29-year-old Hispanic woman was admitted to the emergency department complaining of an intense holocranial headache lasting 9 days, associated with nausea and vomiting. She was discharged home with resolution of the headache but persistence of symptoms. However, she subsequently developed horizontal diplopia and gait abnormalities. She was readmitted to hospital because of anomalous eye movements and conjugate gaze palsy, manifested as bilateral INO. Magnetic resonance angiography (MRA) findings were consistent with dissection of the left V4 vertebral artery with multiple brain infarcts in the superior cerebellar artery territory, comprising both MLF tracts.
Conclusions: In young adults, bilateral INO is normally caused by demyelinating disease. In other patients, common causes include trauma, infections and autoimmune diseases with neurological symptoms. Vascular disease is implicated in over a third of cases.