A Puzzling Ocular Motility Disorder: Apparent Up-Gaze Fatigability in a Patient With Oculomotor Nerve Compression. (4th July 2018)

• Record Type: Journal Article
• Authors: Blanc, Christelle; Bidot, Samuel; Héran, Françoise; Tournaire-Marques, Émilie; Vignal-Clermont, Catherine
• Is Part Of: Neuro-ophthalmology. Volume 42:Number 4(2018)
• Page Start: 242
• Page End: 245
• Publication Date: 2018-07-04
• Subjects: Aneurysm -- myasthenia gravis -- ocular neuromyotonia -- synkinesis -- third nerve dysfunction; Neuroophthalmology -- Periodicals; 617.7
• DOI: 10.1080/01658107.2017.1374416
• Languages: English
• ISSNs: 0165-8107

Abstract

ABSTRACT: We report the case of a woman who developed right third nerve dysfunction with synkinesis and ocular neuromyotonia secondary to a compressive arterial aneurysm. Surprisingly, our examination showed a downward drift of the right eye in sustained up-gaze resulting in transient hypotropia, suggesting either fatigability of the superior rectus or contraction of the inferior rectus. We believe this ocular motility pattern is secondary to a co-contraction of the inferior rectus in up-gaze caused by synkinesis (explaining the downward drift), followed by failure of the inferior rectus to relax upon return to primary position caused by ocular neuromyotonia (explaining the hypotropia).