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Bilateral oculomotor ocular neuromyotonia: a case report
Tanyatuth Padungkiatsagul1, Panitha Jindahra2, Anuchit Poonyathalang1
1Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand.
BMC Neurology
|September 5, 2018
Summary
Ocular neuromyotonia (ONM) causes episodic double vision due to sustained muscle contractions. This rare condition, often linked to radiotherapy, can affect both eyes and is treatable with medication.
Area of Science:
- Neuro-ophthalmology
- Neurology
Background:
- Ocular neuromyotonia (ONM) is a rare condition causing episodic diplopia, typically triggered by sustained eccentric gaze.
- It results from involuntary sustained contractions of extraocular muscles, often following radiotherapy near the parasellar area.
Observation:
- A 60-year-old woman with a history of skull base radiotherapy presented with episodic, painful horizontal binocular diplopia.
- She experienced involuntary sustained medial rectus muscle contractions after prolonged eccentric gaze, leading to transient esotropia in both eyes.
- Neuroimaging ruled out brain lesions or tumor recurrence.
Findings:
- The patient's symptoms were characteristic of bilateral oculomotor ONM affecting the medial rectus muscles.
- Diagnosis was confirmed by observing esotropic episodes upon sustained eccentric gaze.
- Treatment with carbamazepine successfully resolved the symptoms.
Implications:
- ONM should be considered in the differential diagnosis of episodic diplopia, particularly in patients with a history of radiotherapy.
- Careful neuro-ophthalmic examination, including prolonged eccentric gaze testing, is crucial for diagnosing ONM.
- Prompt diagnosis and treatment can prevent extensive and unnecessary investigations.
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