A case with internuclear ophthalmoplegia and intermittent exotropia

SUMMARY A 69-year-old woman was admitted to our emergency clinic with a head trauma and acute onset diplopia following a fall while walking at home. Ophthalmic examination revealed that visual acuity of 20/20 both eyes, pupillary reactions to light and fundus were normal. There was an adduction deficit of right eye and intermittent exotropia of left eye in primary gaze. Ductions were normal in left eye. Left hemiparesis and left positive babinsky were detected by neurological examination. The brain magnetic resonance imaging comfirmed the clinical diagnosis of internuclear ophthalmoplegia as a result of acute ischemic infarction affecting ponto-mesencephalic junction. The adduction deficit, exotropia and the other neurological symptoms resolved in 2 weeks duration. In conclusion, the acute onset of diplopia and exotropia in an old patient with vascular risk factors suggests probability of the acute ponto-mesencephalic junction infarction. Keywords: Diplopia, exotropia, internuclear ophthalmoplegia OZET Ellidokuz yasinda kadin hasta kafa travmasi ve akut baslangicli cift gorme sikayeti ile acil servise basvurdu. Oftalmik muayenesinde gorme keskinligi her iki gozde 20/20, isiga karsi pupiller reaksiyonlar ve fundus normaldi. Sag gozde adduksiyon kusuru ve sol gozde primer bakista intermitan ekzotropya vardi. Sol goz hareketleri normaldi. Norolojik muayenede sol hemiparezi ve sol babinski pozitifligi vardi. Beyin manyetik rezonans goruntuleme, klinik tani internukleer oftalmoplejiyi dogrulayarak akut iskemik ponto-mezensefalik kose infakti ile uyumulu idi. Adduksiyon kusuru, ekzotropya ve diger norolojik bulgular 2 hafta icerisinde kayboldu. Sonuc olarak, vaskuler risk faktoru olan yasli bir kadinda akut baslayan cift gorme ve ekzotropya akut ponto-mezensefalik kose infakti olasiliginida dusundurmelidir. Anahtar sozcukler: Cift gorme, egzotropya, internukleer oftalmopleji