Open AccessOculomotor palsy as a single presenting sign of midbrain hemorrhage
Author(s) -
ChiaYi Lee,
HungChi Chen,
HungYu Lin,
Ling-Yuh Kao
Publication year - 2018
Publication title -
taiwan journal of ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.519
H-Index - 9
eISSN - 2211-5072
pISSN - 2211-5056
DOI - 10.4103/tjo.tjo_110_17
Subject(s) - medicine , diplopia , midbrain , oculomotor nerve palsy , oculomotor nerve , palsy , surgery , brainstem , differential diagnosis , magnetic resonance imaging , trochlear nerve , radiology , central nervous system , pathology , alternative medicine
We report a case presenting with bilateral oculomotor nerve palsy (ONP) resulting from a midbrain hemorrhage. The patient visited the ophthalmological clinic due to the sudden onset of horizontal diplopia for a week. Bilateral ONP spared the left eye levator and bilateral pupils were found while the remaining results of examinations were unremarkable. Cerebral magnetic resonance imaging revealed a midbrain hemorrhage. Mono-ocular occlusion was arranged, and the patient was referred to a neurologist for further management. No further ophthalmic signs developed, but the patient became bedridden due to brainstem hemorrhage and died of aspiration pneumonia 9 months after the onset of the oculomotor signs. It is advocated that midbrain hemorrhage should be included in the differential diagnosis once diplopia develops and that careful neurological investigation of the origin of diplopia is warranted.