HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 62, Number 9, May 11, 2004 Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kim, J. S. Search for Related Content PubMed PubMed Citation Articles by Kim, J. S. Related Collections All Neuro-ophthalmology Ocular motility Diplopia (double vision) All Cerebrovascular disease/Stroke Infarction

Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction

From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.

Address correspondence and reprint requests to Dr. J.S. Kim, Department of Neurology, Asan Medical Center, Song Pa, PO Box 145, Seoul 138-600, Korea; e-mail: jongskim{at}amc.seoul.kr

Objective: To describe the clinical features, MRI findings, and pathogenesis of strokes producing internuclear ophthalmoplegia (INO) as an isolated or predominant clinical manifestation.

Methods: Thirty patients presenting with INO without (n = 12) or with (n = 18) minimal other neurologic signs were studied. MRI and angiogram (conventional in 3, MR angiogram in 27) studies were performed in all of them.

Results: Twenty-four presented with INO, whereas six initially presented with one-and-a-half syndrome that changed into INO. Dorsal brainstem infarcts responsible for the INO were located in the caudal pons in 4, rostral pons in 8, rostral pons and isthmus in 2, isthmus area in 14, isthmus and midbrain in 1, and midbrain in 1 patient. Vascular lesions were found in the posterior circulation in 14 patients (47%): at the basilar artery (BA) in 4, superior cerebellar artery (SCA) in 4, posterior cerebral artery (PCA) in 4, and both the PCA and the SCA in 1. The INO eventually disappeared in all patients, tending to last longer (p = 0.05) when it was associated with other neurologic signs.

Conclusions: Isolated or predominant INO is a unique clinical stroke syndrome caused by small dorsal brainstem infarction. The pathogenesis, however, is heterogeneous, including distal occlusion of small penetrating arteries, atheromatous branch occlusion from the BA, SCA, or PCA, or major BA occlusion. The functional prognosis of these patients is excellent, although the INO tends to last longer when there are other neurologic deficits.

Received October 6, 2003. Accepted in final form January 28, 2004.

This article has been cited by other articles:

				T. C. Frohman, S. Galetta, R. Fox, D. Solomon, D. Straumann, M. Filippi, D. Zee, and E. M. Frohman Pearls & Oy-sters: The medial longitudinal fasciculus in ocular motor physiology Neurology, April 22, 2008; 70(17): e57 - e67. [Abstract] [Full Text] [PDF]

				J. T. Miley, G. J. Rodriguez, E. M. Hernandez, and S. R. Bundlie Teaching NeuroImage: Traumatic internuclear ophthalmoplegia Neurology, January 1, 2008; 70(1): e3 - e4. [Full Text] [PDF]

				T. Buracchio and J. C. Rucker Pearls and oy-sters of localization in ophthalmoparesis Neurology, December 11, 2007; 69(24): E35 - E40. [Abstract] [Full Text] [PDF]

				H.-A. Yi, H.-A. Kim, H. Lee, and R. W Baloh Body lateropulsion as an isolated or predominant symptom of a pontine infarction J. Neurol. Neurosurg. Psychiatry, April 1, 2007; 78(4): 372 - 374. [Abstract] [Full Text] [PDF]

				J. S. Kim and J. Kim Pure midbrain infarction: Clinical, radiologic, and pathophysiologic findings Neurology, April 12, 2005; 64(7): 1227 - 1232. [Abstract] [Full Text] [PDF]

				Aspects of Internuclear Ophthalmoplegia in Stroke Journal Watch Neurology, August 26, 2004; 2004(826): 2 - 2. [Full Text]