Acute isolated medial rectus palsy due to infarction as a result of hypercoagulable state: A case report and literature review

Abstract

Isolated medial rectus palsy in an otherwise healthy individual is a very rare entity. However, this may point towards underlying systemic pathology. This is a case report of an otherwise healthy young adult male who presented with sudden onset non-progressive blurring of vision in right eye. A series of investigations were performed and the patient was diagnosed to have a rheumatological disorder. Isolated muscle palsies in young patient may be masking a systemic disorder and needs to be evaluated thoroughly.

Reply to comments on: Acute isolated medial rectus palsy due to infarction as a result of a hypercoagulable state

“…Firstly, we would like to thank you for your interest in our paper. [ 1 2 ] In the letter to the editor written by you, we would like to clarify certain points. We would like to begin with the fact that although the clinical picture of this patient at presentation was rather a confusing one while describing the clinical features rather being parsimonious we have described the exact turn of events that occurred.…”

Comments on: Acute isolated medial rectus palsy due to infarction as a result of hypercoagulable state: A case report and literature review

“…We read with interest the article titled “acute isolated medial rectus palsy due to infarction as a result of hypercoagulable state: A case report and literature review” by Morya et al . [ 1 ] The authors are rather parsimonious while detailing the clinical picture, cryptic whether it is nuclear or fascicular medial rectus palsy, presumptive about hypercoagulable state and consequent medical treatment and its resolution. The likely diagnosis of internuclear ophthalmoplegia (INO) has been overlooked peremptorily while entertaining restrictive entities despite a negative forced duction test.…”

“…In the present report, the two frequently encountered aspects of INO, absent/weak convergence and accompanying ocular tilt reaction (OTR)/skew deviation due to involvement of otolithic pathways have been completely overlooked. [ 1 2 ] In OTR patient may neither report vertical diplopia nor conjugate torsion and head tilt adopted may be subtle and easily missed. [ 2 ] Therefore, an evaluation of ocular motility with PACT with primary/secondary deviation as well as in 9 cardinal gazes with 9 gaze montage along with subjective and objective evaluation of conjugate fundus torsion, head tilt test results in erect and supine position would have offered missing pieces to the jigsaw.…”