A 44-year-old woman with a history of resolved nasopharyngeal carcinoma presented with an 8-month history of transient binocular horizontal diplopia. She received complete concurrent chemoradiotherapy 7 years ago. Following prolonged eccentric gaze to the right, she developed involuntary contraction of right lateral rectus, which resulted in 60 seconds of right exotropia. These events also occurred following prolonged eccentric gaze to the left, which resulted in left exotropia (video 1 at Neurology.org). Treatment with carbamazepine improved her symptoms (video 2). Ocular neuromyotonia should be included as a differential diagnosis of transient diplopia, especially in those who have undergone prior radiotherapy to the parasellar region.1
AUTHOR CONTRIBUTIONS
Kavin Vanikieti: study concept and design, acquisition of data, analysis and interpretation of data. Joseph F. Rizzo III: study concept and design, acquisition of data, analysis and interpretation of data, study supervision, critical revision of the manuscript for important intellectual content.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
ACKNOWLEDGMENT
Taweevat Attaseth, MD, and Tanyatuth Padungkiatsagul, MD (Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University), edited the videos.
Footnotes
Supplemental data at Neurology.org
Download teaching slides: Neurology.org
- © 2017 American Academy of Neurology
REFERENCE
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