Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report
Abstract Background Cardiac catheterization and endovascular procedures are extensively used in modern medicine, and procedural stroke is one of the major complications that the catheterization laboratory team may face in their everyday work. Recognizing the signs and symptoms of procedural stroke i...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-024-04401-w |
| _version_ | 1797274514109759488 |
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| author | Norachai Sirisreetreerux Krongkamol Ponglikitmongkol |
| author_facet | Norachai Sirisreetreerux Krongkamol Ponglikitmongkol |
| author_sort | Norachai Sirisreetreerux |
| collection | DOAJ |
| description | Abstract Background Cardiac catheterization and endovascular procedures are extensively used in modern medicine, and procedural stroke is one of the major complications that the catheterization laboratory team may face in their everyday work. Recognizing the signs and symptoms of procedural stroke is crucial to ensuring appropriate management. We herein report a case of internuclear ophthalmoplegia that caused blurred vision, diplopia, and dizziness on lateral gaze as an unusual presentation of procedural stroke. Case presentation A 60-year-old Thai woman underwent right partial colectomy and was diagnosed with stage IV diffuse large B-cell lymphoma. Pre-chemotherapy echocardiography revealed mild left ventricular systolic dysfunction, and she therefore underwent diagnostic catheterization. Coronary angiography revealed normal coronary arteries, leading to a diagnosis of non-ischemic cardiomyopathy. After the procedure, she immediately developed dizziness and diplopia. During the right lateral gaze, she exhibited impaired adduction of the left eye and horizontal nystagmus of the right eye. A diagnosis of left internuclear ophthalmoplegia was made. Magnetic resonance imaging revealed a tiny area exhibiting characteristics of an acute infarct in the left paramedian midbrain, including the left medial longitudinal fasciculus, which explained the clinical picture. Another region of restricted diffusion indicating an acute infarct was detected in the right inferior cerebellar hemisphere. Magnetic resonance angiography revealed no significant cerebral artery disease. The patient achieved full neurological recovery 6 weeks after symptom onset. Conclusion This report describes an uncommon presentation of procedural stroke that is likely to be misdiagnosed, especially by medical staff unfamiliar with internuclear ophthalmoplegia. Despite the good prognosis of internuclear ophthalmoplegia, appropriate stroke care is crucial in patients with procedural stroke because of the risk of multiple brain infarcts. |
| first_indexed | 2024-03-07T14:59:28Z |
| format | Article |
| id | doaj.art-717da26f8d224ef1bae77538f50d455a |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-07T14:59:28Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-717da26f8d224ef1bae77538f50d455a2024-03-05T19:14:29ZengBMCJournal of Medical Case Reports1752-19472024-02-011811410.1186/s13256-024-04401-wInternuclear ophthalmoplegia as a presentation of procedural stroke: a case reportNorachai Sirisreetreerux0Krongkamol Ponglikitmongkol1Cardiology Center, Chulabhorn Hospital, Chulabhorn Royal AcademyDepartment of Medicine, Chulabhorn Hospital, Chulabhorn Royal AcademyAbstract Background Cardiac catheterization and endovascular procedures are extensively used in modern medicine, and procedural stroke is one of the major complications that the catheterization laboratory team may face in their everyday work. Recognizing the signs and symptoms of procedural stroke is crucial to ensuring appropriate management. We herein report a case of internuclear ophthalmoplegia that caused blurred vision, diplopia, and dizziness on lateral gaze as an unusual presentation of procedural stroke. Case presentation A 60-year-old Thai woman underwent right partial colectomy and was diagnosed with stage IV diffuse large B-cell lymphoma. Pre-chemotherapy echocardiography revealed mild left ventricular systolic dysfunction, and she therefore underwent diagnostic catheterization. Coronary angiography revealed normal coronary arteries, leading to a diagnosis of non-ischemic cardiomyopathy. After the procedure, she immediately developed dizziness and diplopia. During the right lateral gaze, she exhibited impaired adduction of the left eye and horizontal nystagmus of the right eye. A diagnosis of left internuclear ophthalmoplegia was made. Magnetic resonance imaging revealed a tiny area exhibiting characteristics of an acute infarct in the left paramedian midbrain, including the left medial longitudinal fasciculus, which explained the clinical picture. Another region of restricted diffusion indicating an acute infarct was detected in the right inferior cerebellar hemisphere. Magnetic resonance angiography revealed no significant cerebral artery disease. The patient achieved full neurological recovery 6 weeks after symptom onset. Conclusion This report describes an uncommon presentation of procedural stroke that is likely to be misdiagnosed, especially by medical staff unfamiliar with internuclear ophthalmoplegia. Despite the good prognosis of internuclear ophthalmoplegia, appropriate stroke care is crucial in patients with procedural stroke because of the risk of multiple brain infarcts.https://doi.org/10.1186/s13256-024-04401-wCase reportCoronary angiographyInternuclear ophthalmoplegiaMagnetic resonance imagingProcedural stroke |
| spellingShingle | Norachai Sirisreetreerux Krongkamol Ponglikitmongkol Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report Journal of Medical Case Reports Case report Coronary angiography Internuclear ophthalmoplegia Magnetic resonance imaging Procedural stroke |
| title | Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report |
| title_full | Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report |
| title_fullStr | Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report |
| title_full_unstemmed | Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report |
| title_short | Internuclear ophthalmoplegia as a presentation of procedural stroke: a case report |
| title_sort | internuclear ophthalmoplegia as a presentation of procedural stroke a case report |
| topic | Case report Coronary angiography Internuclear ophthalmoplegia Magnetic resonance imaging Procedural stroke |
| url | https://doi.org/10.1186/s13256-024-04401-w |
| work_keys_str_mv | AT norachaisirisreetreerux internuclearophthalmoplegiaasapresentationofproceduralstrokeacasereport AT krongkamolponglikitmongkol internuclearophthalmoplegiaasapresentationofproceduralstrokeacasereport |