Teaching NeuroImage: Convergence spasm associated with midbrain compression by cerebral aneurysm
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Figure 1 Infrared video stills and search coil recording of convergence spasm
(A–D) Convergence spasm precipitated by fixation on a near target and released after a blink (video, A). (A) During fixation on a distant target, the patient has mid-range pupils. (B) During fixation on a near target, the patient converges and has miotic pupils. (C) After the near target is removed, convergence is maintained. The pupils remain miotic, which helps to differentiate from bilateral sixth nerve palsies. (D) After a blink, the patient is able to re-fixate on the distant target and the pupils return to mid-range diameter. (E) Binocular search coil recording during sinusoidal horizontal smooth pursuit, in which there is a period of convergence spasm that is released by a blink (video, B). (F) The vergence angle progressively increases up to 50° during the period of convergence spasm (gray triangle).
Figure 2 T2-weighted axial MRI demonstrating progressive compression of the midbrain by an expanding aneurysm (arrowheads) arising from the terminal left carotid artery
(A) MRI 5 years prior to onset of symptoms. (B) MRI at the time of presentation with convergence spasm (after endovascular coiling of the aneurysm).
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