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TitreVIth nerve neuromyotonia mimicking intermittent Duane type II
Abstract Nr.1038
ButCase report to illustrate the symptoms, etiologies and treatment of neuromyotonia
MéthodesA 14-year-old girl developped an intermittent exotropia with diplopia and asthenopia on an esophoria ground. Three years before, she was treated with radiotherapy for brainstem medulloblastoma.
RésultatsOcular alignment and motility showed basic esophoria and slight limitation of abduction on the right eye, confirmed by the Lancaster test. After prolonged right lateral gaze and slow return to primary position, an uncontrollable right exotropia occurred. At that moment, when turning her gaze to the left, a decrease of palpebral aperture and a limitation of adduction was noticed on the right eye, mimicking Duane type II motility. This intermittent motility picture associated to brainstem radiotherapy history allowed us to diagnose VIth nerve neuromyotonia on the right eye. Oral treatment with carbamazepine (100mg per day) partially improved symptoms.
ConclusionOcular neuromyotonia is a very rare disorder of ocular motility characterized by intermittent diplopia and strabismus. It is often resulting from an irradiation of the skull base : radiotherapy is supposed to fragilize nerve’s sheaths, leading to spontaneous and repetitive discharges. In our case, neuromyotonia involved the right VI nerve. It occurred after sustained right gaze, leading to active abduction and restriction of adduction of the right eye, a picture similar to intermittent Duane II syndrome. Correct diagnosis of neuromyotonia is important as membrane stabilizer’s treatment may help to improve symptoms.
Auteur 1
NomTAYLOR
InitialesAR
InstitutHôpital Erasme (ULB)
VilleBruxelles
Auteur 2
NomBURUKLAR
InitialesH
InstitutHôpital Erasme (ULB)
VilleBruxelles
Auteur 3
NomVAN HECHEL
InitialesC
InstitutHôpital Erasme (ULB)
VilleBruxelles
Auteur 4
NomCORDONNIER
InitialesM
InstitutHôpital Erasme (ULB)
VilleBruxelles
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