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“This patient has complained of double vision. Please examine their eyes to determine the cause.”
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- Neurological 0%
Internuclear ophthalmoplegia (INO) presents with gaze disturbances; horizontal gaze will be affected while vertical gaze is usually spared. The patients gaze will be affected on the side of the lesion and he/she may complain of diplopia.
It is important to note that patients with unilateral INO will be unable to adduct the affected eye while the normal eye will abduct normally. While those who have bilateral INO will not be able to adduct their eyes while abduction will be functional. Nystagmus will be present in the normal eye in both the cases. Convergence of the eyes will be normal.
This is a disorder that arises when fibres (of 3rd, 4th and 6th nerves) responsible for coordinating the ocular movements are disrupted within the medial longitudinal fasciculus (MLF). The MLF is responsible for controlling the horizontal gaze. Lesions, like stoke in the elderly and multiple sclerosis in the young adults are a common causes, while trauma and mass lesions are, although seldom, also contributory.
Initial investigations include baseline studies: full blood count, electrolyte levels, renal functions, coagulation studies along with cholesterol and lipid profiles should be done. In older patients, vascular pathology such as stroke (vertebrobasilar artery) or aneurysms may require careful investigations with CT or MRI scans. Additionally, angiography may also be required to test for malformations or occlusive lesions. In younger patients where autoimmune aetiologies are suspected, antinuclear antibodies should be tested for along with CRP and ESR to determine longstanding inflammatory aetiologies. Cases of embolism may require careful cardiac assessment to check for atherosclerotic changes.
The treatment is chosen according to the underlying pathology. Stroke patients need careful assessment and hospital management. In practice, the prognosis of INO depends on the type of pathology present. In benign cases INO may resolve, while severe pathologies may leave permanent and lasting effects.
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Question 1 of 5
1. Question1 point(s)Category: Neurological
What is the diagnosis?CorrectIncorrect
Question 2 of 5
2. Question1 point(s)Category: Neurological
Damage to what part of the brain causes an internuclear ophthalmoplegia?CorrectIncorrect
Question 3 of 5
3. Question1 point(s)Category: Neurological
What is the likely cause of a bilateral internuclear ophthalmoplegia in a young patient?CorrectIncorrect
Question 4 of 5
4. Question1 point(s)Category: Neurological
What is the commonest cause of a unilateral internuclear ophthalmoplegia in an older patient?CorrectIncorrect
Question 5 of 5
5. Question1 point(s)Category: Neurological
You identify that a patient has an internuclear ophthalmoplegia with a defect in left adduction. On which side is the lesion located?CorrectIncorrect