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Partial Third Nerve Palsy and Ocular Neuromyotonia From Displacement of Posterior Communicating Artery Detected by High-Resolution MRI

Cruz, Franz Marie MD; Blitz, Ari M. MD; Subramanian, Prem S. MD, PhD

Section Editor(s): McCulley, Timothy J. MD

doi: 10.1097/WNO.0b013e31829eb397
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Abstract: Ocular neuromyotonia is an unusual condition in which sustained, undesired contraction of one or more extraocular muscles occurs after normal muscle activation. Although most commonly reported after paraseller cranial irradiation for tumor, chronic nonaneurysmal vascular compression of the third nerve can produce partial ocular motor nerve paresis and ocular neuromyotonia. A 75-year-old woman presented with intermittent left-gaze-evoked binocular diplopia. She had an incomplete right third nerve palsy but became symptomatically diplopic and esotropic upon sustained left gaze. High-resolution brain magnetic resonance imaging showed displacement of the right posterior communicating artery and contact with the right third nerve. Gaze-evoked diplopia resolved with carbamazepine, but a partial third nerve paresis remained.

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Wilmer Eye Institute (FMZ, PSS), The Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Neuroradiology (AMB), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.

Address correspondence to Prem S. Subramanian, MD, PhD, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287; E-mail:

Supported in part by an unrestricted grant to the Wilmer Eye Institute from Research to Prevent Blindness, Inc, New York, NY.

The authors report no conflicts of interest.

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© 2013 by North American Neuro-Ophthalmology Society