A brainstem lesion of any type that involves the medial longitudinal fasciculus ( MLF) can cause internuclear ophthalmoplegia (INO). This primarily affects. Internuclear ophthalmoplegia is an ocular movement disorder caused by a lesion of the medial longitudinal fasciculus. It is characterized by. Internuclear ophthalmoplegia is the inability to move both your eyes together when looking to the side. It can affect one or both of your eyes.

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A study of 20 cases and review of the literature. This page was last edited on 24 Novemberat If you have an acute stroke, hospitalization may be required.

The signs of INO may be so clear that little testing is needed to confirm the diagnosis.

Receptive aphasia Hemispatial neglect Gerstmann syndrome Astereognosis occipital lobe: Surgical correction of strabismus may be used for patients with wall-eyed bilateral internuclear ophthalmoplegia. Symptoms Horizontal diplopia Difficulty tracking fast-moving objects Possible vertical oblique diplopia. Learn about esotropia, including its types and how its treated in infants and adults. He also had a stroke in without known permanent vision changes. Internuclear Ophthalmoplegia Kaberi B.

In one review of INO, some of the most common causes included: Disorders of ocular muscles, binocular movement, accommodation and refraction. This syndrome is characterized by having one-and-a-half syndrome and a facial fascicular nerve CN VII palsy. Patients with internuclear ophthalmoplegia report symptoms of varying severity.

Apart from a few minor scrapes she came through the ordeal relatively unscathed. Although there is impaired adduction in the ipsilateral eye, some patients may have normal convergence. Internuclear ophthalmoplegia INO is a deficit in the control of conjugate eye movements, which results from damage to the medial longitudinal fasciculus MLF. Supplementary blood and cerebrospinal fluid CSF studies may be undertaken to detect uncommon causes.

Due to a mismatch in saccadic movements between the eyes, patients may also report difficulties in tracking fast-moving objects [3]. She was asked to look internucleear her right: The medial longitudinal fasciculus in ocular internucleaf physiology. Ischemic and demyelinating INO typically recover. The MLF provides a connection between CN3 nucleus in the midbrain and, therefore, the medial rectus and the CN6 nucleus in the pons abducens on the opposite side and facilitates conjugate eye movements on lateral gaze.


With an INO, patients most commonly complain of horizontal diplopia due to dysconjugate gaze, or less commonly vertical-oblique diplopia resulting from ophthalmopkegia associated skew deviation [1,2].

Look left, look right

The eye that can abduct may exhibit horizontal nystagmus when it does so. Please see the EyeRounds atlas entry on eight-and-a-half syndrome intrnuclear more information. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world.

A syndrome that consists of an INO in one eye combined with an ipsilateral CN VI fascicular involvement with sparing of the sixth nerve nucleus.

Internuclear Ophthalmoplegia

On discharge, the patient was scheduled to follow-up with neurology and neuro-ophthalmology 3 ophthalmopllegia later. Skew deviation is a vertical misalignment of eyes caused by asymmetrical disruption of supranuclear input from the otolithic organs of the inner ear. Nystagmus occurs in 90 percent of people with INO.

Demyelination due to multiple sclerosis is the more common cause in younger populations [4].

That is, if ophtthalmoplegia right eye is affected the patient will “see double” when looking to the left, seeing two images side-by-side. The contralateral abducting eye may demonstrate a dissociated horizontal nystagmus. Other pathologies require management by a physician e. A Fresnel prism is a thin plastic film that attaches to the back surface of your eyeglasses to correct double vision.

He returned to sleep, however, symptoms did not improve later that day. When looking to the left, your right eye will not turn as far as it should. If you continue using our website, we’ll assume that you are happy to receive all cookies on this website. If the INO affects the left eye, the lesion is on the right same side as the eye with the complete conjugate gaze palsy.


Once the diagnosis is made, your doctor may do imaging tests to discover where the damage is located. Residents and Fellows contest rules International Ophthalmologists contest rules.

Internuclear Ophthalmoplegia From EyeWiki. Expressive aphasia Aboulia parietal lobe: The INO can be unilateral or bilateral and may present with or without neurologically isolated other brainstem findings. Turns out carbs alone can’t be faulted for any weight issues – it’s the combination of how and what opthhalmoplegia. It is the reverse of the typical INO, and although the lesion localization is not consistent, it likely is due to CN VI pre-nuclear input asymmetry [7]. A chief diagnostic sign is slowed adducting saccadic velocity in the eye with the adduction deficit.

When itnernuclear attempt is made to gaze contralaterally relative to the affected eyethe affected eye adducts minimally, if at all. The patient was admitted to the neurology stroke service and the lesion was felt to be atherosclerotic in nature, based on its location. The cause is because the abducent excitatory interneurons fail to reach the medial rectus subnucleus.

However, examination of her ocular movements demonstrated an abnormal finding. Disordered inhibition in internuclear ophthalmoplegia: Review Wall-eyed bilateral internuclear ophthalmoplegia: Management MRI Treatment of the underlying cause. In young patients with bilateral INO, multiple sclerosis is often the cause.

However, recent studies have disproved this ophthzlmoplegia and retained convergence is thought to reflect the innate ability to converge to near targets.