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We describe 3 cases of Chiari type II malformation presenting with bilateral internuclear ophthalmoplegia(INO).Although prominent,the INO was not an isolated sign in any of the patients;superimposed abduction paresis was present in 2,and deficits in smooth pursuit,optokinetic nystagmus,and vestibulo-ocular responses were present in 3.Two had hydrocephalus:1 was clinically unchanged without therapy after 5 years;the other did not improve with shunting.Findings in our 3 patients,along with the 4 previously reported,confirm that INO is 1 manifestation of widespread brainstem or cerebellar dysfunction.Its origin is probably multifactorial, related to hydrocephalus,vascular compromise,direct neuronal distortion,or congenital neural malformation. |
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