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KMID : 1036520110010010069
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Clinical Neuro-Ophthalmology
2011 Volume.1 No. 1 p.69 ~ p.71
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A Transition from Wall Eyed Bilateral Internuclear Ophthalmoplegia to Unilateral Internuclear Ophthalmoplegia with Skew Deviation
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Oh Dong-Seok
Jung Hyun-Jung
Yun Geum-Jin
Lee Seung-Han
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Abstract
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Internuclear ophthalmoplegia (INO) could be developed by lesions invading the medial longitudinal fasciculus (MLF) unilaterally or bilaterally. Among various etiologies, ischemic stroke involving the brainstem tegmentum is one of the most common causes. Here we report a patient with a dorsomedial pontomesencephalic infarction who initially presented with wall eyed bilateral INO (WEBINO) that changed into unilateral INO with exotropia and skew deviation within 24 hours. In the acute stage of ischemic stroke, neuro-ophthalmologic manifestations could be dynamic, and detection of these changes might be useful for the assessment of the clinical course. Furthermore, the presence of skew deviation only in unilateral INO suggests that the functional balance of the MLF is important for the manifestation of ocular tilt reaction.
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KEYWORD
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Internuclear ophthalmoplegia, Exotropia, Skew deviation, Brainstem infarction
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