Bilateral Internuclear Ophthalmoplegia in a Young Woman with Vertebral Artery Dissection

• DOI: 10.12890/2019_001105
• Publication Date: 2019-06-28T08:46:45Z
• Authors: Omar Cárdenas; Enrique Gomez; Mariana Marcín; Adib Jorge de Sar...; Verónica Sánchez; Juan Manuel Calleja
• Keywords: Internuclear ophthalmoplegia; Medial longitudinal fasciculus; Vertebral artery dissection; Etiology; Superior cerebellar artery

Internuclear ophthalmoplegia (INO) is an eye movement disorder caused by a lesion in the medial longitudinal fasciculus (MLF) located midbrain. Adduction paralysis of both eyes and bilateral abduction nystagmus are main features INO[1].A 29-year-old Hispanic woman was admitted to emergency department complaining intense holocranial headache lasting 9 days, associated with nausea vomiting. She discharged home resolution but persistence symptoms. However, she subsequently developed horizontal diplopia gait abnormalities. readmitted hospital because anomalous movements conjugate gaze palsy, manifested as INO. Magnetic resonance angiography (MRA) findings were consistent dissection left V4 vertebral artery multiple brain infarcts superior cerebellar territory, comprising MLF tracts.In young adults, INO normally demyelinating disease. In other patients, common causes include trauma, infections autoimmune diseases neurological Vascular disease implicated over third cases.A vascular aetiology should be suspected when internuclear presents headache.Almost patients have identified cause.Magnetic imaging gold standard for investigating