A rare case of paroxysmal diplopia: ocular neuromyotonia

Pessa, Maria Elena; Verriello, Lorenzo; Pauletto, Giada; Gigli, Gian Luigi; Valente, Mariarosaria

doi:10.1007/s10072-018-3460-9

Cited by 4 publications

(2 citation statements)

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“…While most cases are unilateral, there have been some bilateral cases reported [7,8]. Patients can exhibit normal ocular motility between episodes or demonstrate deviations in primary positions consistent with a contraction of the affected EOM [3,9]. For example, a left exotropia develops following prolonged left gaze due to contraction of the left lateral rectus, as seen in Fig.…”

Section: Clinical Presentationmentioning

confidence: 99%

Ocular neuromyotonia: a review of diagnosis and treatment

Lee

2022

Current Opinion in Ophthalmology

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Purpose of reviewThe current review will cover the clinical presentation, causes, epidemiology, differential diagnoses, workup, and treatment of ocular neuromyotonia (ONM) in detail.Recent findingsWhile ONM largely remains a unilateral eye movement disease affecting adults with a history of sellar radiation, recent case reports highlight an expansion of this presentation to include bilateral, pediatric, and congenital cases.SummaryONM is a rare but recognizable ocular motility disorder involving sustained contraction of the extraocular muscle, commonly resulting in intermittent diplopia. Diagnosis of ONM relies upon a thorough history and clinical exam, with particular attention to history of radiotherapy and eccentric gaze testing. Treatment with carbamazepine remains first-line therapy, although other membrane stabilizing agents and surgical interventions can be effective.

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Section: Clinical Presentationmentioning

confidence: 99%

Ocular neuromyotonia: a review of diagnosis and treatment

Lee

2022

Current Opinion in Ophthalmology

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“…Case 5 had examination findings and history that pointed toward adult onset neuromyotonia, which can occur after brain or orbit radiation (17,18) or rarely in patients with thyroid orbitopathy (19). The repeated episodes of activation of one or more muscles innervated by CN III can occur spontaneously or can be provoked by extreme gaze or by light stimuli, as in this case.…”

Section: Case 5: Radiation-induced Cn III Palsy With Neuromyotoniamentioning

confidence: 99%

Oculomotor Nerve Palsy Due to Unusual Causes

Tian

Kardon

Feng

et al. 2020

Journal of Neuro-Ophthalmology

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Background: An isolated oculomotor nerve (CN III) palsy is a diagnostic concern because of the potential for serious morbidity or life-threatening causes. We present 5 unusual causes of oculomotor nerve palsy that escaped initial diagnosis in order to raise awareness of their associated features that will facilitate correct diagnosis. Methods: This study consisted of a retrospective analysis of clinical features and imaging of 5 patients who were referred for neuro-ophthalmologic evaluation with presumed diagnosis of oculomotor nerve palsy of unknown reasons.Results: A complete CN III palsy and an inferior division CN III palsy were diagnosed with a schwannoma in the cavernous sinus and orbital apex portion, respectively; a middle-aged woman with aberrant regeneration was found to have a small meningioma; an adult man with ptosis was diagnosed with cyclic oculomotor paresis with spasms; and a patient after radiation was diagnosed with neuromyotonia. Conclusions: Localizing the lesion of oculomotor nerve palsy and careful examination of the imaging is crucial. Aberrant regeneration, cyclic pupil changes, and past medical history of amblyopia, strabismus, or radiation are also very helpful for diagnosis.

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Rare Diseases Day and Brain Awareness Week: the active participation of Neurological Sciences

Federico

2019

Neurol Sci

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A rare case of paroxysmal diplopia: ocular neuromyotonia

Cited by 4 publications

References 4 publications

Ocular neuromyotonia: a review of diagnosis and treatment

Ocular neuromyotonia: a review of diagnosis and treatment

Oculomotor Nerve Palsy Due to Unusual Causes

Rare Diseases Day and Brain Awareness Week: the active participation of Neurological Sciences

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