Mild 6th nerve palsy due to pontine stroke

Update item information
Identifier Fascicular_6th_NP_alternate_cover
Title Mild 6th nerve palsy due to pontine stroke
Subject Abnormal Alignment, Abnormal Range, Sixth Nerve Palsy
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
Description This is a 70-year-old woman with HTN and diabetes who presented with horizontal diplopia for several weeks, worse in right gaze. There was a very subtle abduction paresis OD with full motility elsewhere. With cover-uncover testing, there was a small esotropia in right gaze (esodeviation seen with alternate cover testing in this video), and with alternate cover testing there was a very subtle esophoria in primary gaze at distance, and she was orthophoric in left gaze. MRI showed a small subacute stroke involving the right 6th nerve fascicle within the pons. There was evidence of fibromuscular dysplasia involving the right vertebral artery, and this was thought to be the most likely cause of her pontine stroke. Commonly in patients with diplopia, motility is normal or near normal, so that localization is not possible without measurements of alignment. Alternate cover, cover-uncover testing and/or Maddox rod testing should be performed.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2017
Format video/mp4
Rights Management Copyright 2017. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s61k34jn
Setname ehsl_novel_gold
Date Created 2017-07-26
Date Modified 2018-01-22
ID 1256238
Reference URL
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