A patient presents with diplopia with limitations of adduction in the left eye and abducting saccade in the right eye. Convergence is preserved. Most likely etiology is:
B. i.e. Internuclear opthalmoplegia In type III internuclear opthalmoplegia, none of the eyes abduct completely while the adduction is complete (Le. normal convergence)Q. Dissociated Opthalmoplegia There is dissociation in gaze movements i.e. one eye moves in one direction whereas the other eye cannot move in the same direction. Internuclear Opthalmoplegia (INO) Medial longitudinal Fasciculus (MLF) connects 3rd and 6th nerve nuclei. A lesion in MLF produces INO and prevents harmonious coordination of these nuclei in producing conjugate (both eye moving in same direction)" movements. Etiologies may be Unilateral Bilateral - Vascular lesion or infarct of small branch - Multiple sclerosis (m.imp) of basilar aery (m.imp) - Neoplasm - Brain stem tumors - Inflammation - Multiple sclerosis - Myasthenia gravis - Myasthenia gravis - Occlusive vascular disease - Cryptococcosis
Paial 3rd nerve palsy
Internuclear ophthalmoplegia
Duane's reactionary syndrome
Absence of medial rectus muscle