Pediatric Internuclear Ophthalmoplegia

Abstract

While rare, INO in a pediatric patient requires a full neurologic evaluation and careful follow-up to assess eye position and potentially treat amblyopia.

Clinical Reasoning: A 12-Year-Old Girl With Acute-Onset Diplopia, Dizziness, and Upbeat Nystagmus

“…Most of the adult cases of INO are related to brainstem ischemia and demyelinating disorders like multiple sclerosis. 1,4 INO is relatively poorly described in children and some of the common causes reported are brainstem tumors like gliomas and medulloblastomas, trauma and hemorrhage. 4 Ischemic strokes, being uncommon in children, have only been reported to cause INO in patients with sickle cell disease, lupus, Fabry's disease, etc.…”

“…4 Ischemic strokes, being uncommon in children, have only been reported to cause INO in patients with sickle cell disease, lupus, Fabry disease, and so on. 4 Bilateral INO of subacute onset in adults and children is mostly related to demyelinating diseases. 1,4 This patient's brain MRI showed a small area of diffusion restriction at the junction of the medial midbrain and pons in the dorsal region on the right side (eFigure 1, links.lww.com/ WNL/C472).…”

“…4 Bilateral INO of subacute onset in adults and children is mostly related to demyelinating diseases. 1,4 This patient's brain MRI showed a small area of diffusion restriction at the junction of the medial midbrain and pons in the dorsal region on the right side (eFigure 1, links.lww.com/ WNL/C472). No other lesions suggestive of a demyelinating nature were seen.…”

“…4 Bilateral INO of subacute onset in adults and children is mostly related to demyelinating diseases. 1,4…”

“…1,4 INO is relatively poorly described in children, and some of the common causes reported are brainstem tumors like gliomas and medulloblastomas, trauma, and hemorrhage. 4 Ischemic strokes, being uncommon in children, have only been reported to cause INO in patients with sickle cell disease, lupus, Fabry disease, and so on. 4 Bilateral INO of subacute onset in adults and children is mostly related to demyelinating diseases.…”