A 26-year-old woman presented with a one-year history of horizontal binocular diplopia on far-right gaze. During a routine eye examination for contact lenses, she was found to have a gaze paretic nystagmus on far-right gaze. The patient also offered a one-year history of right-sided instability and balance issues. MRI was done, and she was admitted to our institution for further evaluation and management. Further history revealed that she experienced diplopia in primary position after running a mile. She denied headache, nausea, vomiting, and other visual symptoms. She denied antecedent trauma or illness. She denied variability of diplopia or associated ptosis. Neuro-ophthalmologic examination showed 20/20 vision bilaterally, with normal pupils and color vision. External examination revealed mild orbicularis weakness. Corneal sensation was mildly reduced in both eyes. Motility showed a mild right esotropia on right gaze from a subtle sixth nerve paresis. There was a gaze paretic nystagmus in right gaze as well. Slit lamp examination was normal. Fundus examination was normal with pink optic nerves. General neurologic examination showed no other focal deficits. MRI was reviewed; CT head and MRI spine were additional tests performed. Spinal fluid analysis was not done because of concerns for herniation. Numerous laboratory studies were performed. A diagnostic procedure was performed.
Date
2019-03
Language
eng
Format
video/mp4
Source
2019 North American Neuro-Ophthalmology Society Annual Meeting