New-onset Oscillopsia in a Patient With a History of Pontine Stroke

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Title New-onset Oscillopsia in a Patient With a History of Pontine Stroke
Creator Anna Kabanovski; Laura Donaldson; Edward Margolin
Affiliation Faculty of Medicine (AK), University of Toronto, Toronto, Canada; Faculty of Medicine (LD, EM), Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and Faculty of Medicine (EM), Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
Abstract A 69-year-old man with a history of pontine hemorrhage 2 years ago noticed binocular vertical diplopia after the stroke. On examination, there was a small-angle incomitant left hyperdeviation that did not fit the 3-step test for fourth nerve palsy and incyclotorsion of the higher eye. On motility testing, there was an obvious pendular nystagmus. Resting tremor of the right hand was noticed on neurological examination. Examination of the oropharynx revealed rhythmic oscillations of the soft palate synchronous with the eye oscillations and hand tremor. These findings established a diagnosis of oculopalatal myoclonus (OPM). Although OPM is a well-described entity, this case is unique because the patient was completely asymptomatic from OPM and did not complain of oscillopsia but was very bothered by vertical diplopia because of skew deviation. It also demonstrates that OPM may coexist with skew deviation because anatomically vestibulo-ocular pathway is close to the triangle of Guillain-Mollaret and patients with lesions in one pathway should be examined for abnormalities in the other. Finally, it reminds us about the importance of monitoring patients with a history of brainstem insults for emergence of synchronous tremors years later and that simple maneuver-like ex/amining oropharynx may provide a clear diagnosis.
Subject Diplopia; Pathologic Nystagmus; Ocular Motility Disorders; Strabismus; Stroke; Tremor Vision Disorders
OCR Text Show
Date 2022-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2023, Volume 43, Issue 2
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s63f5k5a
Setname ehsl_novel_jno
ID 2307897
Reference URL https://collections.lib.utah.edu/ark:/87278/s63f5k5a
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