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Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia

Published online by Cambridge University Press:  21 May 2015

Glen Jickling ,
Kelvin Leung ,
Kenman Gan ,
Ashfaq Shuaib ,
James Lewis  and
Mikael S. Mouradian
Glen Jickling
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alta.
Kelvin Leung
Affiliation:
University of Alberta, School of Medicine, Edmonton, Alta.
Kenman Gan
Affiliation:
Department of Ophthalmology, University of Alberta, Edmonton, Alta.
Ashfaq Shuaib
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alta.
James Lewis
Affiliation:
Department of Ophthalmology, University of Alberta, Edmonton, Alta.
Mikael S. Mouradian*
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alta.
*
2121 Pease St., Ste. 1D, Harlingen TX 78550; mikael.muratoglu@valleybaptist.net

Abstract

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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.

Keywords

bilateral internuclear ophthalmoplegiavertebral artery dissectiondiplopia
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 485 - 487
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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