Internuclear ophthalmoplegia - Revision history

NadavNahumi: /* Differential Diagnosis */

2020-03-28T23:25:01Z

Differential Diagnosis

← Older revision		Revision as of 23:25, 28 March 2020
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	*[[Stroke]]		*[[Stroke]]
	*[[brain tumor\|Malignancy]] located in brainstem and 4th ventricle		*[[brain tumor\|Malignancy]] located in brainstem and 4th ventricle
	*[[third nerve palsy\|CN III palsy]]		*[[third nerve palsy\|CN III palsy]] would show additional deficit including weakness of elevation, ptosis, pupil dilation

	==Evaluation==		==Evaluation==

ClaireLewis at 22:36, 2 October 2019

2019-10-02T22:36:52Z

← Older revision		Revision as of 22:36, 2 October 2019
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	==Background==		==Background==
	*[[Focal neuro deficit]] caused by injury or dysfunction of medial longitudinal fasciculus		*[[Focal neuro deficit]] caused by injury or dysfunction of medial longitudinal fasciculus
			*Paramedian Pontine Reticular Formation (PPRF) is the conjugate gaze center for horizontal eye movements. Innervates ipsilateral Abducens (CN VI) nucleus. Abducens nucleus signals ipsilateral lateral rectus to contract and sends a second via MLF to contralateral oculomotor (CN III) nucleus, causing contraction on the contralateral medial rectus.
			*Associated with one and one-half syndrome (lesion involving the PPRF and ipsilateral MLF)

	==Clinical Features==		==Clinical Features==
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	*Impaired adduction when attempted to gaze contralaterally to affected eye		*Impaired adduction when attempted to gaze contralaterally to affected eye
	*Contralateral eye abducts with [[nystagmus]]		*Contralateral eye abducts with [[nystagmus]]
	*Divergence of eyes~~-->~~ horizontal [[diplopia]]		*Divergence of eyes results in horizontal [[diplopia]] when looking contralateral (to affected eye)
			*Convergence remains intact (differentiates CN III palsy from INO)

	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Multiple sclerosis]] (most common cause in young patients)		*[[Multiple sclerosis]] (most common cause in young patients)
	*[[Stroke]]		*[[Stroke]]
			*[[brain tumor\|Malignancy]] located in brainstem and 4th ventricle
			*[[third nerve palsy\|CN III palsy]]

	==Evaluation==		==Evaluation==
	*Evaluate for underlying cause based on clinical presentation		*Evaluate for underlying cause based on clinical presentation
			*The use of optokinetic tape is highly sensitive for testing for INO
			*[[brain MRI\|MRI]]

	==Management==		==Management==
	*Treat underlying condition		*Treat underlying condition
			*Symptoms will often resolve on their own. Patients with cerebrovascular disease are less likely to have recovery.
			*Patching of eye can aid in relief of diplopia
			*Diframpadine, potassium channel blocker, has been used in patients with demyelinating disease


	==Disposition==		==Disposition==
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	<references/>		<references/>
	[[Category:Symptoms]] [[Category:Neurology]]		[[Category:Symptoms]] [[Category:Neurology]]
			Ropper A, Klein J, Samuels M. Adams and Victor's Principles of Neurology 10th Edition. McGraw-Hill Education / Medical; 2014.
			<references/>
			Serra A, Skelly MM, Jacobs JB, et al. Improvement of internuclear ophthalmoparesis in multiple sclerosis with dalfampridine. Neurology 2014; 83:192.

ClaireLewis: Created page with "==Background== *Focal neuro deficit caused by injury or dysfunction of medial longitudinal fasciculus ==Clinical Features== File:R MLF injury-R INO.jpg|thumb|Schematic..."

2019-09-08T15:51:07Z

Created page with "==Background== *Focal neuro deficit caused by injury or dysfunction of medial longitudinal fasciculus ==Clinical Features== File:R MLF injury-R INO.jpg|thumb|Schematic..."

New page

==Background==
*[[Focal neuro deficit]] caused by injury or dysfunction of medial longitudinal fasciculus

==Clinical Features==
[[File:R MLF injury-R INO.jpg|thumb|Schematic of right internuclear ophthalmoplegia caused by injury to right medial longitudinal fasciculus]]

*Impaired adduction when attempted to gaze contralaterally to affected eye
*Contralateral eye abducts with [[nystagmus]]
*Divergence of eyes--> horizontal [[diplopia]]

==Differential Diagnosis==
*[[Multiple sclerosis]] (most common cause in young patients)
*[[Stroke]]

==Evaluation==
*Evaluate for underlying cause based on clinical presentation

==Management==
*Treat underlying condition

==Disposition==

==See Also==

==External Links==

==References==
<references/>
[[Category:Symptoms]] [[Category:Neurology]]