- Internuclear ophthalmoplegia (INO) is well known for its association with multiple sclerosis in young patients and ischaemic stroke in older patients. Lesions of the medial longitudinal fasciculus produce the clinical findings of INO. Wernicke encephalopathy (WE) is a metabolic disorder of thiamine deficiency that classically presents with confusion, ataxia, and nystagmus. Diplopia and ophthalmoplegia can also be the presenting or predominant complaint in WE. We report a case of WE presenting with an INO who had same-day resolution of symptoms and signs after high-dose parenteral thiamine.
- Leber hereditary optic neuropathy (LHON) is an inherited mitochondrial disorder that typically presents in young men with painless, subacute, bilateral (simultaneous or sequential) central vision loss.1,2 Most cases have nonsimultaneous involvement of the contralateral eye in an interval less than 1 year.2,3 However, there are reports of loss of vision in the fellow eye over 1 year later. To date, the longest interval between affected eyes is 18 years.4 We present a patient with an interval of 41 years.
- An 84-year-old female with history of hypertension and hyperlipidemia presented with nontraumatic left eyelid edema, erythema, and ptosis followed by acute painless binocular horizontal diplopia. Best corrected visual acuity was 20/20 OD and 20/30 OS. The OD pupil measured 4 mm in the dark and 2 mm in the light, and the OS pupil measured 3 mm in the dark and 2 mm in the light. No relative afferent pupillary defect was detected. There was a 50 prism diopter esotropia in primary gaze and an abduction deficit of –4 OS (Fig.