Korean J Neurotrauma.  2016 Oct;12(2):140-143. 10.13004/kjnt.2016.12.2.140.

A Case of Traumatic Unilateral Internuclear Ophthalmoplegia: Clinical Significance of Susceptibility-Weighted Imaging

• Lee SH
• Nam TK
• Park YS
• Kwon JT

• KMID: 2356788
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.140

Abstract

A 43-year-old man was admitted for head trauma after falling backward. The patient complained of diplopia. Unilateral internuclear ophthalmoplegia (INO) was diagnosed during the neurologic examination. Initially, no specific finding was shown on T2-weighted, T1-weighted, and fluid attenuated inversion recovery brain magnetic resonance image (MRI) or brain computed tomography (CT). However, susceptibility-weighted imaging (SWI) definitively demonstrated a tiny hemorrhage at the midline of the pontomesencephalic junction. The patient's symptom improved after 12 weeks. We discuss the clinical significance of SWI when traumatic INO due to a tiny hemorrhage is suspected.

Keyword

Trauma; Hemorrhage; Internuclear ophthalmoplegia; Susceptibility-weighted imaging

MeSH Terms

Accidental Falls
Adult
Brain
Craniocerebral Trauma
Diplopia
Hemorrhage
Humans
Neurologic Examination
Ocular Motility Disorders*

Figure

• 

  FIGURE 1 Neuro-ophthalmologic examination of the patient. (A) One day after head trauma. (B) Twelve weeks after head trauma.

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  FIGURE 2 Neuro-image findings of the patient. (A) Brain computed tomography. (B) T1-weighted image (WI). (C) T2-WI. (D) Fluid-attenuated inversion recovery image. (E) Susceptibility-WI (SWI). The white arrows in C, D and E indicate signal changes in the pontomesencephalic junction. The SWI E most definitely revealed a microhemorrhage.

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