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Internuclear ophthalmoplegia: MR-anatomic correlation.

S W Atlas, R I Grossman, P J Savino

    AJNR. American Journal of Neuroradiology
    |March 1, 1987
    PubMed
    Summary
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    Magnetic resonance imaging (MRI) effectively detects lesions in the medial longitudinal fasciculus causing internuclear ophthalmoplegia. MRI is superior to CT for diagnosing this brainstem gaze disorder.

    Area of Science:

    • Neuroimaging
    • Neurology
    • Ophthalmology

    Background:

    • Internuclear ophthalmoplegia is a gaze palsy resulting from medial longitudinal fasciculus lesions.
    • This condition presents with impaired eye adduction and dissociated nystagmus.

    Purpose of the Study:

    • To evaluate the utility of MRI in diagnosing internuclear ophthalmoplegia.
    • To correlate MRI findings with the medial longitudinal fasciculus anatomy.

    Main Methods:

    • Eleven patients with internuclear ophthalmoplegia underwent 1.5-T MRI (spin-echo).
    • Nine patients also had CT scans.
    • Four patients received gadolinium-DTPA contrast for enhanced MRI.

    Main Results:

    • MRI detected medial longitudinal fasciculus lesions in 10 of 11 patients (high T2 signal).

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  • Contrast-enhanced MRI revealed an active lesion in one patient with recent onset.
  • CT scans failed to detect lesions in all examined patients.

    • Conclusions:

    • MRI is superior to CT for evaluating brainstem dysfunction causing internuclear ophthalmoplegia.
    • MRI findings correlate well with the neuroanatomy of the medial longitudinal fasciculus.
    • MRI can identify active lesions indicative of blood-brain barrier disruption.