Article Text
PDF
Abstract
A young man in his 20s sustained head and body injuries after a fall from a height, 1 year ago for which he received emergency medical and surgical intervention. A month after the trauma, he noticed outward deviation of the right eye intermittently but did not experience diplopia. On examination, he had a bilateral adduction deficit, bilateral abduction nystagmus and a bilateral vertical nystagmus. The MRI (plain) showed an old haematoma with haemosiderin staining of the posterior midbrain and pons (extending to the bilateral medial longitudinal fasciculi). The patient was managed conservatively and was followed up closely. The present case describes bilateral internuclear ophthalmoplegia presenting subtly (without manifest exotropia or accompanying diplopia); hence, the condition remained undiagnosed. Though internuclear ophthalmoplegia (INO) due to demyelinating disease, ischaemia and infection may have a good prognosis; INO due to traumatic haemorrhage with chronic haematoma formation may take time to recover or become irreversible.
- Neuroopthalmology
- Visual pathway
Statistics from Altmetric.com
Footnotes
Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SDO and PH-B. The following authors gave final approval of the manuscript: SDO and PH-B. SDO is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.