A patient noticed double vision while watching tennis. They cannot look past the center from either eye. Here the patient is looking to their left.
A patient presented with an adduction deficit in both eyes; what do you suspect is the cause?
- Right CN III palsy
- Left CN VI palsy
- Bilateral intranuclear ophthalmoplegia
- Congenital 4th (CN IV) nerve palsy
Analysis
Watch this video to see the patient's versions.
This patient had an ipsilateral adduction deficit on both right and left gaze. On further examination, she had slow adducting saccadic velocity on both sides.
The patient was diagnosed with bilateral internuclear ophthalmoplegia (INO).
In this 5-minute video with Dr. Paul Freund, you will review:
- The signs of internuclear ophthalmoplegia found on examination
- The location of lesions associated with INO
- Causes of INO and other pathologies that affect the extraocular muscles
Neuro Coach Tip
Disconjugate lateral gaze with impairment of adduction should raise suspicion for internuclear ophthalmoplegia (INO).
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