• Users Online: 89051
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO THE EDITOR
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1230-1231

Reply to comments on: Acute isolated medial rectus palsy due to infarction as a result of a hypercoagulable state


Associate Professor & Unit Head, Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Web Publication25-May-2020

Correspondence Address:
Dr. Arvind K Morya
Associate Professor & Unit Head, Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2414_19

Rights and Permissions

How to cite this article:
Morya AK. Reply to comments on: Acute isolated medial rectus palsy due to infarction as a result of a hypercoagulable state. Indian J Ophthalmol 2020;68:1230-1

How to cite this URL:
Morya AK. Reply to comments on: Acute isolated medial rectus palsy due to infarction as a result of a hypercoagulable state. Indian J Ophthalmol [serial online] 2020 [cited 2024 Mar 29];68:1230-1. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2020/68/6/1230/284841



Respected Sir,

Firstly, we would like to thank you for your interest in our paper.[1],[2] In the letter to the editor written by you, we would like to clarify certain points. We would like to begin with the fact that although the clinical picture of this patient at presentation was rather a confusing one while describing the clinical features rather being parsimonious we have described the exact turn of events that occurred. The diagnosis of internuclear ophthalmoplegia did not occur at the initial presentation since there was no evidence of nystagmus in the other eye at presentation. Hence, instead of presuming the diagnosis, we advised a review of reports of MRI being conducted elsewhere and were reported to be normal. As per the discussion with the radiologist, we came to the conclusion that the previous MRI had thick slices and completely ruled out any pathology hence, repeat MRI with the smaller cuts was required. Therefore, the patient was subjected to a repeat MRI. Meanwhile, the patient was examined multiple times by the ophthalmologists and the neurologist. In addition, the patient was started on corticosteroid suspecting inflammatory etiology. However, after the reports were available the steroids were tapered off. We did not have a higher-end machine-like oculography and hence, we relied on our clinical examinations. The extraocular movements were examined by multiple ophthalmologists in normal and in slow motion, and video recording of all the movements was also taken. However, we could not detect any nystagmus. In the literature search, we came across the reports of isolated medial rectus palsy that could relate to our case.[3],[4],[5],[6] As rightly mentioned by you, the subtle findings of nystagmus, ocular tilt reaction, or skew deviation could have been easily missed. Nevertheless, as we could not base our diagnosis on presumption, we considered a differential diagnosis of both. The comment on whether it was nuclear fascicular in nature again cannot be based completely on the clinical findings, as the case was atypical in presentation. We did exclude all the other risk factors of ischemia stating why hypertension, dyslipidemia, and smoking were considered a risk factor since none of their histories were positive and were not being mentioned previously. Considering the clinical feature, we preferred the diagnosis of isolated MR palsy to partial or unilateral INO, as there was no supporting evidence for the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pandey PK, Kishore D, Saraf P, Chaudhary RB, Sachdeva N, Muni I. Comments on: Acute isolated medial rectus palsy due to infarction as a result of hypercoagulable state: A case report and literature review. Indian J Ophthalmol 2020;68:1229-30.  Back to cited text no. 1
  [Full text]  
2.
Morya AK, Jangid K, Naidu A, Bhandari S, Prakash S, Gogia S. Acute isolated medial rectus palsy due to infarction of as a result of hypercoagulable state; A case report and literature review. Indian J Ophthalmol 2019;67:1898-900.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Al-Sofiani M, Lee Kwen P. Isolated medial rectus nuclear palsy as a rare presentation of midbrain infarction. Am J Case Rep 2015;16:715-8. Published 2015 Oct 8. doi: 10.12659/AJCR.893875.  Back to cited text no. 3
    
4.
Bal S, Lal V, Khurana D, Prabhakar S. Midbrain infarct presenting as isolated medial rectus palsy. Neurol India 2009;57:499-501.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Rabadi MH, Beltmann MA. Midbrain infarction presenting isolated medial rectus nuclear palsy. Am J Med 2005;118:836-7.  Back to cited text no. 5
    
6.
Yao Y, Hong W, Fan Z, Li D, Chang X, Fan W. Isolated medial rectus palsy: Rare presentation of mesencephalon infarction. J Stroke Cerebrovasc Dis 2017;26:e53-4.  Back to cited text no. 6
    




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed759    
    Printed25    
    Emailed0    
    PDF Downloaded76    
    Comments [Add]    

Recommend this journal