Bilateral Internuclear Ophthalmoplegia After Trauma

Abstract

To our knowledge, this is the first reported case of bilateral internuclear ophthalmoplegia secondary to trauma. A young man was admitted with complaints of persistent double vision and rhinorrhea following an automobile accident that resulted in transient loss of consciousness and multiple anterior fossa skull fractures. Results of examination showed anosmia, cerebrospinal rhinorrhea, and bilateral paresis of adduction with nystagmus of the abducting eye. Operative repair of the cerebrospinal fluid fistula was performed without complication. Six weeks after injury, return of function began with slow, but progressive Improvement that continues one year later. We describe the pathophysiology by which trauma could produce a lesion relatively restricted to the area of the median longitudinal fasciculus. The most plausible mechanism appears to be traumatic displacement of the brain stem, with the subsequent development of mechanical shear forces within the stem.