Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-22T20:19:33.074Z Has data issue: false hasContentIssue false
  • English
  • Français

Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia

Published online by Cambridge University Press:  21 May 2015

Glen Jickling ,
Kelvin Leung ,
Kenman Gan ,
Ashfaq Shuaib ,
James Lewis  and
Mikael S. Mouradian
Glen Jickling
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alta.
Kelvin Leung
Affiliation:
University of Alberta, School of Medicine, Edmonton, Alta.
Kenman Gan
Affiliation:
Department of Ophthalmology, University of Alberta, Edmonton, Alta.
Ashfaq Shuaib
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alta.
James Lewis
Affiliation:
Department of Ophthalmology, University of Alberta, Edmonton, Alta.
Mikael S. Mouradian*
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alta.
*
2121 Pease St., Ste. 1D, Harlingen TX 78550; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

A 21-year-old woman presented to the emergency department 1 day after a fall. On the day of presentation, she awoke with horizontal diplopia and posterior neck pain. Based on clinical findings, she was diagnosed with bilateral internuclear ophthalmoplegia. A conventional angiogram identified a left vertebral artery dissection. She was started on anticoagulant therapy, with gradual improvement of her diplopia over several months. Diplopia is frequently seen in the emergency department. Internuclear ophthalmoplegia is a cause of binocular diplopia and is important to recognize because it indicates a brainstem lesion requiring neurologic evaluation.

Keywords

bilateral internuclear ophthalmoplegiavertebral artery dissectiondiplopia
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 485 - 487
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Kline, LB, Bajandas, FJ.Neuro-ophthalmology review manual. Rev. 5th ed. Thorofare (NJ): Slack; 2004. p. 67–9.Google Scholar
2.Keane, JR.Internuclear ophthalmoplegia. Unusual causes in 114 of 410 patients. Arch Neurol 2005;62:714–7.Google Scholar
3.Walsh, WP, Hafner, JF, Kattah, JC.Bilateral internuclear ophthalmoplegia following minor head trauma. J Emerg Med 2003;24:19–22.CrossRefGoogle ScholarPubMed
4.Kim, JS.Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction. Neurology 2004;62:1491–6.Google Scholar
5.Bolanos, I, Lozano, D, Cantú, C.Internuclear ophthalmoplegia: causes and long-term follow-up in 65 patients. Acta Neurol Scand 2004;110:161–5.Google Scholar
6.Arnold, M, Bousser, MG, Fahrni, G, et al.Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 2006;37:2499–503.CrossRefGoogle ScholarPubMed
7.Lyrer, P, Engelter, S.Antithrombotic drugs for carotid artery dissection. Cochrane Database Syst Rev 2003;(3):CD000255.Google Scholar
8.Cohen, JE, Leker, RR, Gotkine, M, et al.Emergent stenting to treat patients with carotid artery dissection: clinically and radiologically directed therapeutic decision making. Stroke 2003;34:e254–7.CrossRefGoogle ScholarPubMed