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Published on: July 21, 2013
Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia
Glen Jickling1, Kelvin Leung, Kenman Gan
1Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
CJEM
|October 2, 2008
Summary
A young woman experienced double vision and neck pain after a fall, diagnosed with internuclear ophthalmoplegia. This condition, linked to a vertebral artery dissection, highlights the need for neurological evaluation in emergency cases.
Area of Science:
- Neurology
- Vascular Neurology
- Ophthalmology
Background:
- Diplopia is a common emergency department complaint.
- Internuclear ophthalmoplegia (INO) is a specific cause of binocular diplopia.
- INO suggests a lesion within the brainstem, necessitating urgent neurological assessment.
Observation:
- A 21-year-old female presented with acute onset horizontal diplopia and posterior neck pain post-fall.
- Clinical examination revealed bilateral internuclear ophthalmoplegia.
- Conventional angiography confirmed a left vertebral artery dissection.
Findings:
- Vertebral artery dissection can manifest with neurological deficits including INO.
- Anticoagulant therapy was initiated for the dissection.
- Gradual improvement in diplopia was observed over several months.
Implications:
- This case underscores the importance of considering vascular etiologies, such as vertebral artery dissection, in young adults presenting with diplopia and neck pain.
- Recognizing internuclear ophthalmoplegia is crucial for identifying potentially life-threatening brainstem lesions.
- Prompt neurological evaluation and vascular imaging are essential for accurate diagnosis and management of such cases.
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