A Puzzling Ocular Motility Disorder: Apparent Up-Gaze Fatigability in a Patient With Oculomotor Nerve Compression

We report the case of a woman who developed right third nerve dysfunction with synkinesis and ocular neuromyotonia secondary to a compressive arterial aneurysm. Surprisingly, our examination showed a downward drift of the right eye in sustained up-gaze resulting in transient hypotropia, suggesting e...

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Bibliographic Details
Published in:Neuro-ophthalmology (Aeolus Press) 2018, Vol.42 (4), p.242-245
Main Authors: Blanc, Christelle, Bidot, Samuel, Héran, Françoise, Tournaire-Marques, Émilie, Vignal-Clermont, Catherine
Format: Report
Language:English
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Summary:We report the case of a woman who developed right third nerve dysfunction with synkinesis and ocular neuromyotonia secondary to a compressive arterial aneurysm. Surprisingly, our examination showed a downward drift of the right eye in sustained up-gaze resulting in transient hypotropia, suggesting either fatigability of the superior rectus or contraction of the inferior rectus. We believe this ocular motility pattern is secondary to a co-contraction of the inferior rectus in up-gaze caused by synkinesis (explaining the downward drift), followed by failure of the inferior rectus to relax upon return to primary position caused by ocular neuromyotonia (explaining the hypotropia).
ISSN:0165-8107
DOI:10.1080/01658107.2017.1374416