Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia.
A 21-year-old woman presented to the emergency department 1 day after a fall. On the day of presentation, she awoke with horizontal diplopia and posterior neck pain. Based on clinical findings, she was diagnosed with bilateral internuclear ophthalmoplegia. A conventional angiogram identified a left vertebral artery dissection. She was started on anticoagulant therapy, with gradual improvement of her diplopia over several months. Diplopia is frequently seen in the emergency department. Internuclear ophthalmoplegia is a cause of binocular diplopia and is important to recognize because it indicates a brainstem lesion requiring neurologic evaluation.
Jickling
Glen
G
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Leung
Kelvin
K
Gan
Kenman
K
Shuaib
Ashfaq
A
Lewis
James
J
Mouradian
Mikael S
MS
D000058:Accidental Falls; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
D000925:Anticoagulants