II. Pathophysiology

  1. Medial Longitudinal Fasciculus (MLF) - normal function
    1. On lateral gaze, Cranial Nerve 6 abducts the ipsilateral eye
    2. To maintain Conjugate Gaze, a signal is passed via MLF to the contralateral eye's CN 3 to adduct (medially) in parallel
  2. With a MLF lesion, the adducting eye via CN 3 fails to adduct
    1. In response, the abducting eye (via CN 6) demonstrates Nystagmus and Conjugate Gaze Palsy
  3. Extraocular Movement is normal in other directions
    1. Primary gaze remains parallel
    2. Eye convergence on near Vision remains intact

III. Causes

  1. Older adults (esp. unilateral involvement)
    1. Vascular disease affecting the vertebrobasilar circulation
  2. Young adults (esp. bilateral involvement)
    1. Multiple Sclerosis
  3. Children
    1. Pontine glioma (MRI)
    2. Vasculitis may also cause Internuclear Ophthalmoplegia in this age group
  4. Alcoholism
    1. Wernicke's Encephalopathy

IV. References

  1. Berson (1990) Ophthalmology Study Guide, AAO, p. 116-7

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Related Studies

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Concepts Disease or Syndrome (T047)
MSH D015835
ICD9 378.86
ICD10 H51.2
SnomedCT 49823009
English INO - Internucl ophthalmopleg, Ophthalmoplegia, Internuclear, Internuclear Ophthalmoplegias, Ophthalmoplegias, Internuclear, Internucl ophthalmopleg, lhermitte's syndrome, internuclear ophthalmoplegia, Internuclear ophthalmoplegia, Ophthalmoplegia internuclearis, Lhermitte's syndrome, Bielschowsky-Lutz-Cogan syndrome, INO - Internuclear ophthalmoplegia, Internuclear ophthalmoplegia (disorder), internuclear; ophthalmoplegia, ophthalmoplegia; internuclear, Internuclear Ophthalmoplegia
Dutch internucleaire oftalmoplegie, internucleair; oftalmoplegie, oftalmoplegie; internucleair, Internucleaire oftalmoplegie, Oftalmoplegie, internucleaire
French Ophthalmoplégie internucléaire, Ophtalmoplégie internucléaire
German internukleaere Ophthalmoplegie, Internukleäre Ophthalmoplegie, Internukleaere Ophthalmoplegie
Portuguese Oftalmoplegia internuclear, Oftalmoplegia Internuclear
Spanish Oftalmoplejía internuclear, Oftalmoplejía Internuclear, oftalmoplejía internuclear (trastorno), oftalmoplejía internuclear, síndrome de Bielschowsky - Lutz - Cogan, síndrome de Lhermitte
Japanese 核間性麻痺, カクカンセイマヒ
Czech Internukleární oftalmoplegie, internukleární oftalmoplegie
Korean 핵간 안근마비
Hungarian Internuclearis ophtamoplegia
Norwegian Internukleær oftalmoplegi
Italian Oftalmoplegia internucleare

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Concepts Disease or Syndrome (T047)
ICD9 378.81
ICD10 H51.0
SnomedCT 193169002, 194130001, 1534008
Dutch geconjugeerde oogspierverlamming, geconjugeerd; blikparalyse, Verlamming van geconjugeerde blik
French Paralysie avec déviation conjuguée des yeux
German konjugierte Blicklaehmung, Konjugierte Blicklaehmung
Italian Paralisi dello sguardo coniugato
Portuguese Perturbação dos movimentos oculares coordenados
Spanish Parálisis de la mirada conjugada, parálisis de la mirada conjugada (trastorno), parálisis de la mirada conjugada
Japanese 共同注視麻痺, キョウドウチュウシマヒ
English conjugate gaze palsy, conjugate gaze palsy (diagnosis), Conjugate gaze palsy (disorder), Palsy of conjugate gaze, Conjugate gaze palsy, Palsy of conjugate gaze (disorder), conjugate; gaze, palsy, Conjugate gaze palsy [Ambiguous]
Czech Obrna konjugovaného pohledu
Korean 공동주시 마비
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Ontology: Medial longitudinal fasciculus syndrome (C1963860)

Concepts Disease or Syndrome (T047)
English Medial longitudinal fasciculus syndrome
Spanish Síndrome del fascículo longitudinal medial
French Syndrome du faisceau longitudinal médian
Dutch Medial Longitudinal Fasciculus-syndroom
Portuguese Síndrome do fascículo longitudinal medial
German Faszikulus longitudinalis medialis-Syndrom
Italian Sindrome del fascicolo longitudinale-mediale
Japanese 内側縦束症候群, ナイソクジュウソクショウコウグン
Czech Syndrom mediálního longitudinálního fascikulu
Hungarian Medialis longitudinalis köteg syndroma