Torsional internuclear ophthalmoplegia in acute ischemic stroke

A 45-year-old man with no medical history woke up with acute binocular diplopia. Clinical examination revealed disturbances in eye movements (video 1). MRI showed a recent infarction in the left posteromedial mesencephalon (figures 1 and 2). Lesions of this type can result in inactivation of the interstitial nucleus of Cajal which causes an ipsilateral torsional quick phase nystagmus,1 as well as inactivation of the left medial longitudinal fascicle, which causes a left-sided internuclear ophthalmoplegia.2 Within 24 hours, symptoms had resolved completely.
Source: Neurology Clinical Practice - Category: Neurology Authors: Tags: Stroke in young adults, DWI, Clinical neurology examination, All Cerebrovascular disease/Stroke Case Source Type: research