Traumatic Ophthalmoplegia In A Pediatric Patient

Approximately 3 to 7% of patients with head injuries have ocular motor palsies, most commonly of the third, fourth, and sixth cranial nerves. Internuclear Ophthalmoplegia (INO) is an uncommon complication from closed head trauma. INO is characterized by a paresis of adduction in lateral gaze and a horizontal jerk nystagmus in the abducting fellow eye. Most often, an INO is caused by a lesion or demyelination in the Medial Longitudinal Fasciculus (MLF). Traumatic INO often results from stretching MLF tract fibers or from shear forces in the brainstem which stretch branches of the basilar artery which leads to ischemia. Prognosis of traumatic INO is typically good but correlation of radiographic evidence to clinical findings is often missing.