[Ocular motility disorder as a primary symptom of temporal arteritis]

HISTORY AND METHODS: Six weeks after onset of a monocular elevation paresis of the left eye a 78-year-old man presented with an anterior ischemic optic neuropathy of the right eye. This time a monocular elevation paresis was observed in the right eye. The diagnosis of arteritis temporalis was confirmed histologically.

Systemic steroid therapy was administered. Five days later the patient developed signs of an acute vertebrobasilar insufficiency. After further steroid therapy the neurologic signs and the motility disorder resolved. The visual acuity of the right eye improved from 1/20 to 6/20, but the visual field remained poor.

In retrospect the monocular elevation paresis was the initial sign of the temporal arteritis. The combination of the affected muscles and the change of the affected eye were hints at a prenuclear origin of the paresis. General signs of an acute vertebrobasilar ischemia supported this supposed localisation.