A Case of Acquired Ocular Motor Apraxia Accompanied with Esotropia due to Multiple Brain Infarcts

Yong Dae Kim; Seong Joon Kim

doi:10.3341/jkos.2014.55.9.1396

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Kim and Kim: A Case of Acquired Ocular Motor Apraxia Accompanied with Esotropia due to Multiple Brain Infarcts

Case Report

J Korean Ophthalmol Soc 2014;55(9):1396-1400.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1396

A Case of Acquired Ocular Motor Apraxia Accompanied with Esotropia due to Multiple Brain Infarcts

Yong Dae Kim, MD¹, Seong Joon Kim, MD, PhD^1,^2,

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

Address reprint requests to Seong Joon Kim, MD, PhD, Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea, Tel: 82-2-2072-1979, Fax: 82-2-741-3187, E-mail: ophjun@gmail.com

Received 26 April 2014 Revised 14 May 2014 Accepted 17 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We present a case of acquired ocular motor apraxia accompanied with esotropia due to multiple brain infarcts.

Case summary

A 59-year-old male was referred for diplopia that started 9 years before presentation and continued after multiple brain infracts including right cerebellum, right occipital lobe, medulla oblongata and inferior pons. At initial examination, his best corrected visual acuity was 20/22 in the right eye and 20/25 in the left eye and he had 12 prism diopter (PD) esotropia at distance and near in primary gaze with correction. His duction and version were normal; however, his horizontal saccade was notably decreased. Two years and 8 months after presentation, the patient had 15 PD esotropia at distance and near with correction. His duction and version were normal and vertical saccadic eye movements were observed. However, horizontal saccade disappeared. The patient also exhibited a distinguishing head thrust following the order for saccadic eye movement. He was diagnosed with an acquired ocular motor apraxia accompanied with esotropia. During the follow-up period the patient underwent bilateral recession of the medial rectus. The usual diplopia and his horizontal esodeviation improved to 3 PD of esotropia at distance.

Conclusions

Multiple brain infarcts can result in an acquired ocular motor apraxia accompanied with esotropia. Varying types of ocular motor disorders should be considered in patients with a previous medical history of brain infarct.

Keywords: Diplopia, Esotropia, Head thrust, Infarct, Ocular motor apraxia

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Figure 1.

T2-weighted axial brain magnetic resonance imaging (MRI) demonstrated high signal intensities of the right cerebellum (arrows) (A), and medulla oblongata (arrow) (B) 9 years before presentation. Axial diffusion MRI also showed high signal intensities of pons (arrow) (C), and the right occipital lobe (arrow) (D) at the same time. One year after presentation, axial MRI showed persistent lesion of the pons obtained on T2-weighted image (arrow) (E) and that of the occipital lobe obtained on flair image (arrow) (F) without significant interval change.

Figure 2.

Nine cardinal photographs showing small esotropia in primary gaze without limitation of duction and version 2 years and 8 months after presentation. Left ptosis is also observed.

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