Internuclear Ophthalmoplegia in Childhood

Internuclear Ophthalmoplegia in Childhood

HARVARD MEDICAL SCHOOLDEPARTMENT OF NEUROLOGY

MASSACHUSETTS GENERAL HOSPITAL

HARVARD MEDICAL SCHOOLDEPARTMENT OF NEUROLOGY

MASSACHUSETTS GENERAL HOSPITAL

HARVARD MEDICAL SCHOOLDEPARTMENT OF NEUROLOGY

MASSACHUSETTS GENERAL HOSPITAL

Shirley H. Wray, M.D., Ph.D.

Professor of Neurology, Harvard Medical School

Director, Unit for Neurovisual Disorders

Massachusetts General Hospital

Figure 1A: Primary gaze.

B: Gaze Right. Left internuclear ophthalmoplegia

C: Gaze left. Right internuclear ophthalmoplegia.

Figure 2: Pneumoencephalography: blockage of the aqueduct.

Figure 3: Pneumoencephalography: obstructive hydrocephalus. Enlarged ventricles.

Figure 4: Enlarged ventricles, obstructive hydrocephalus.

Figure 5: Histological section: Medulloblastoma.

Bilateral Internuclear Ophthalmoplegia in Children

A manifestation of Brain Stem Tumor6 cases – 3 boys, 3 girlsAges 4.5, 7.5, 9.5, 10, 16, and 17 yearsDuration of symptoms: 9 mos. – 6 years (4/6

dead)Other Symptoms: Headache 4

Papilledema 1 Clumsiness 4

Pathology Medulloblastoma 1 Medulloblastoma or Glioma 2 Infiltrating Glioma 1

Cogan DG, Wray SH. Neurology. 1970. 20: 629 – 633.

References

Cogan DG, Kubik CS, Smith JL. Unilateral internuclear ophthalmoplegia: report of 8 clinical cases with 1 post-mortem study. Arch Ophthalmol 1950; 44:783-796.

Cogan DG, Wray SH. Internuclear ophthalmoplegia as an early sign of brainstem tumor. Neurology 1970; 20:629-633.

Cogan DG. Internuclear opthalmoplegia typical and atypical. Arch Ophthalmol 1970; 84:583-589.

Keane JR. Internuclear ophthalmoplegia: unusual causes in 114 of 410 patients. Arch Neurol. 2005 May; 62(5):714-7.

http://www.library.med.utah.edu/NOVEL