Ocular Neuromyotonia Noted after Recent Botulinum Toxin Injection for Sixth Nerve Palsy Following Resection of a Posterior Fossa Skull Base Meningioma

Abstract

A 56-year-old female complained of diplopia immediately after surgical excision of a recurrent left skull base tuberculum meningioma. She was found to have a left sixth nerve palsy, which was subsequently treated with botulinum toxin injection to the medial rectus muscle. Three months post injection, the patient had partial recovery of the sixth nerve palsy and new-onset ocular neuromyotonia.

Ocular neuromyotonia: a review of diagnosis and treatment

“…Other causes of ONM as reported in the literature include hypovitaminosis D [3], congenital [22], alcohol ingestion [23], Paget disease of bone [24], myelogram with thorium toxicity [25], cavernous sinus thrombosis secondary to mucormycosis [26], intramedullary stroke [27], chronic inflammatory demyelinating disease [28], botulinum toxin injection [29], brainstem demyelination [30], Tolosa–Hunt syndrome [31], idiopathic [32], intracranial tumor [33], and as a presenting sign of meningioma [34].…”