Ocular neuromyotonia with spastic lid closure.
Ocular neuromyotonia is characterized by tonic spasms of extraocular muscles evoked by eccentric gaze that induces transient strabismus and diplopia. We report the case of a 70-year-old woman who initially presented with unilateral deficits in fifth and sixth cranial nerve functions attributed to a fifth cranial nerve schwannoma. After radiation treatment, she developed neuromyotonia and synkinesis of the ipsilateral third cranial nerve. During the attacks of neuromyotonia, the left eyelids were often spastically closed, a phenomenon not previously reported. The ocular neuromyotonia regressed spontaneously within 3 years, but components of the synkinesis persisted. Ephaptic transmission in a damaged third cranial nerve may be responsible for the neuromyotonia and synkinesis. Synkinesis is a more enduring manifestation.
Oohira
Akihiko
A
Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan. ohira@wakaba-hp.or.jp
Furuya
Tatsuyuki
T
D020434:Abducens Nerve Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001369:Axons / Q000473:pathology / Q000528:radiation effects; D003390:Cranial Nerve Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy; D005141:Eyelid Diseases / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology; D009410:Nerve Degeneration / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009442:Neurilemmoma / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D015835:Ocular Motility Disorders / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D009802:Oculomotor Nerve / Q000473:pathology / Q000503:physiopathology / Q000528:radiation effects*; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011878:Radiotherapy / Q000009:adverse effects*; D016896:Treatment Outcome; D020433:Trigeminal Nerve Diseases / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy
D000927:Anticonvulsants