Abstract Details

Title Bilateral Internuclear Ophthalmoplegia in Neuromyelitis Optica Spectrum Disorder

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P02 - (-)

Poster/Presentation
Number 257

Objective

Background BACKGROUND: Neuromyelitis Optica (NMO) and NMO spectrum disorders are increasingly recognized clinical entities. Outside of typical cases, the physician must use clinical clues to determine whether it is appropriate to evaluate for NMO. Recent studies show that some NMO brain lesions tend to be located in the hypothalamus and around the third and fourth ventricles. This distinctive localization provides an opportunity to assist in the diagnosis of NMO, as is seen in the case we present here.

Design/Methods DESIGN/METHODS: A 36 year old female with a history of cervical transverse myelitis presented with several days of horizontal binocular diplopia. Examination revealed bilateral internuclear ophthalmoplegia. Initial serum studies were unremarkable. CSF examination showed 13 leukocytes (97% lymphocytes), 660 erythrocytes, normal glucose and protein, and greater than 5 oligoclonal bands. MRI brain showed gadolinium enhancement and T2 signal hyperintensity in the hypothalamus and along the floor of the fourth ventricle.

Results RESULTS: She received methylprednisolone 1000mg IV daily for 5 days, followed by plasma exchange. Towards the end of her course of plasma exchange her internuclear ophthalmoplegia improved. Serum NMO antibody testing was positive.

Conclusions CONCLUSIONS: Bilateral INO has been described infrequently in NMO. Yet, the high density of aquaporin channel expression near the floor of the fourth ventricle, adjacent to the medial longitudinal fasciculus, provides a neuro-anatomic rationale for bilateral INO in NMO spectrum disorders. NMO, in addition to multiple sclerosis, should be considered in cases of bilateral INO.

Authors/Disclosures
Sean Gratton, MD (University Health) PRESENTER	Dr. Gratton has received personal compensation in the range of $0-$499 for serving as a Annual Meeting Planning Committee with Kansas City Clinical Neuroscience Society.
Benjamin J. Osborne, MD, FAAN (Medstar Georgetown University Hospital)	Dr. Osborne has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Osborne has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Osborne has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. Osborne has received publishing royalties from a publication relating to health care.
Fahd Amjad, MD (Georgetown University Hospital)	Dr. Amjad has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for TEVA. Dr. Amjad has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Acadia. Dr. Amjad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merz. Dr. Amjad has received personal compensation in the range of $0-$499 for serving as a Consultant for abbvie. Dr. Amjad has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal. Dr. Amjad has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Kyowna Kirin. Dr. Amjad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine. Dr. Amjad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for This information is included in the consultant disclosure. The institution of Dr. Amjad has received research support from Roche.
	No disclosure on file
	No disclosure on file

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