Partial Third Nerve Palsy and Ocular Neuromyotonia From Displacement of Posterior Communicating Artery Detected by High-Resolution MRI

Cruz, Franz Marie; Blitz, Ari M.; Subramanian, Prem S.

doi:10.1097/wno.0b013e31829eb397

Cited by 14 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to the limitation of vertical ocular motility, our patient's medial rectus and levator palpebrae OD failed to relax following normal contraction in adduction and up-gaze, respectively. This ocular motor pattern is diagnostic for ocular neuromyotonia (ONM) involving the third cranial nerve, [1][2][3] which is commonly associated with eyelid synkinesis. 1,2,[4][5][6] The patient was started on carbamazepine 200 mg twice daily which reduced the frequency of the spells by the 3-week follow up.…”

Section: Interpretation and Discussionmentioning

confidence: 99%

A Puzzling Ocular Motility Disorder: Apparent Up-Gaze Fatigability in a Patient With Oculomotor Nerve Compression

Blanc

Bidot

Héran

et al. 2017

Neuro-Ophthalmology

View full text Add to dashboard Cite

We report the case of a woman who developed right third nerve dysfunction with synkinesis and ocular neuromyotonia secondary to a compressive arterial aneurysm. Surprisingly, our examination showed a downward drift of the right eye in sustained up-gaze resulting in transient hypotropia, suggesting either fatigability of the superior rectus or contraction of the inferior rectus. We believe this ocular motility pattern is secondary to a co-contraction of the inferior rectus in up-gaze caused by synkinesis (explaining the downward drift), followed by failure of the inferior rectus to relax upon return to primary position caused by ocular neuromyotonia (explaining the hypotropia).

show abstract

Section: Interpretation and Discussionmentioning

confidence: 99%

A Puzzling Ocular Motility Disorder: Apparent Up-Gaze Fatigability in a Patient With Oculomotor Nerve Compression

Blanc

Bidot

Héran

et al. 2017

Neuro-Ophthalmology

View full text Add to dashboard Cite

show abstract

“…6 Symptoms may appear as early as two months or as late as 17 years after treatment. 4 Other reported aetiologies include compressive lesions like meningioma, 7 arterial aneurysms, 8,9 Graves orbitopathy 9 and Tolosa-Hunt syndrome. 10 In a few patients, no definitive cause could be ascertained despite extensive evaluation.…”

Section: Discussionmentioning

confidence: 99%

A novel association of ocular neuromyotonia with brainstem demyelination: Two case reports

et al. 2014

View full text Add to dashboard Cite

Ocular neuromyotonia (ONM) is a rare disorder of ocular mal-alignment in which painless, transient spontaneous or gaze-induced abnormal deviation of the eye manifests as episodic diplopia. With only a few cases reported in the literature, ONM mostly follows months to years after cranial irradiation for sellar or suprasellar lesions. Here we present two patients with this rare ocular condition, secondary to brainstem demyelination, the association of which is hitherto unreported in the literature. Both patients were 15-year-old girls who presented to us with episodic forced-eye deviation with diplopia. Examination during these attacks revealed ONM involving the superior rectus and medial rectus in the first and second patient, respectively. There was clinical evidence of intrinsic brainstem involvement with downbeat nystagmus and skew deviation in one patient without any other cerebellar or long tract signs. MRI showed evidence of demyelination involving the brainstem in both, with CSF showing positive immunological markers and with positive aquaporin-4 antibody in one patient. Both patients responded remarkably to immunomodulatory therapy and are asymptomatic at follow-up. That ONM can occur with brainstem demyelination has not been reported in the literature. This association may help in explaining the pathophysiology of ONM as secondary to segmental demyelination.

show abstract

“…1 Without thin, heavily T2-weighted constructive interference in steady state or FIESTA (fast imaging employing steady-state acquisition) sequences, neurovascular contact can be missed. 2 ONM has also been associated with radiation therapy, thyroid eye disease, mass lesions, or superior oblique myokymia. 1 If diplopia manifests or worsens after prolonged eccentric gaze, ONM should be considered.…”

mentioning

confidence: 99%

Teaching Neuro Images : Ocular neuromyotonia

Gold

2016

Neurology

View full text Add to dashboard Cite

A 63-year-old man presented with several months of intermittent vertical diplopia mainly while reading. He consistently developed a transient right hypertropia (with left supraduction deficit) after looking down for approximately 10 seconds and then back to primary (figure 1). Neurovascular contact between the left third nerve and posterior cerebral artery was demonstrated with magnetic resonance constructive interference in steady state imaging (figure e-1 on the Neurology ® Web site at Neurology.org), and episodes were resolved with carbamazepine. Aside from presumed transient tonic contraction of the left inferior rectus, there was no evidence that other third-innervated muscles were involved.When vascular compression of an ocular motor nerve causes ocular neuromyotonia (ONM), it is thought that ephaptic transmission is responsible. Axonal "cross-talk" causes irritability and abnormal firing independent of the synapse.1 Without thin, heavily T2-weighted constructive interference in steady state or FIESTA (fast imaging employing steady-state acquisition) sequences, neurovascular contact can be missed.2 ONM has also been associated with radiation therapy, thyroid eye disease, mass lesions, or superior oblique myokymia.1 If diplopia manifests or worsens after prolonged eccentric gaze, ONM should be considered. STUDY FUNDINGNo targeted funding reported. From the

show abstract

Partial Third Nerve Palsy and Ocular Neuromyotonia From Displacement of Posterior Communicating Artery Detected by High-Resolution MRI

Cited by 14 publications

References 11 publications

A Puzzling Ocular Motility Disorder: Apparent Up-Gaze Fatigability in a Patient With Oculomotor Nerve Compression

A Puzzling Ocular Motility Disorder: Apparent Up-Gaze Fatigability in a Patient With Oculomotor Nerve Compression

A novel association of ocular neuromyotonia with brainstem demyelination: Two case reports

Teaching Neuro Images : Ocular neuromyotonia

Contact Info

Product

Resources

About