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Neuromyelitis optica patient presenting binocular vertical diplopia

Philippe Rizek, David Nicolle, Keng Yeow Tay, Marcelo Kremenchutzky (2014) Multiple Sclerosis and Related Disorders 3, 273-275.

Neuromyelitis optica patient presenting binocular vertical diplopia

A 25 year-old right-handed woman complains of double vision. On examination she had a chin down position, as this eased the symptoms.

Two years prior she was shown positive for aquaporin-4 antibodies and was diagnosed with neuromyelitis optica (NMO). Since the initial presentation of traverse myelitis she had remained symptom-free. She had discontinued immunosuppressive therapy for the past year, due to pregnancy and breast-feeding. She is still breast-feeding and prefers to remain off therapy.

Neuro-ophthalmic examination revealed that on cross- cover testing she had a right hypertropia on left gaze and a left hypertropia on right gaze. No significant extra-ocular muscle imbalance was detected in primary position, nor was there nystagmus, internuclear ophthalmoplegia, ptosis or pupil asymmetry. The remainder of the neuro-ophthalmic examination was normal. In conclusion, she presented binocular vertical diplopia that was improved with tilting her head down.

A spinal MRI was made (fig 1) and a cranial MRI (fig 2) was made. The latter could be compared with a similar MRI from 33 months ago.

spinal MRI cranial MRI compared with 33 months ago


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About the Editors

  • Prof Timothy Vartanian

    Timothy Vartanian, Professor at the Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, Cornell...
  • Dr Claire S. Riley

    Claire S. Riley, MD is an assistant attending neurologist and assistant professor of neurology in the Neurological Institute, Columbia University,...
  • Dr Rebecca Farber

    Rebecca Farber, MD is an attending neurologist and assistant professor of neurology at the Neurological Institute, Columbia University, in New...

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