Prognosis of ischemic internuclear ophthalmoplegia

Objectives: To determine the prognosis of internuclear ophthalmoplegia (INO) caused by infarction. Design: Multicenter, retrospective observational case series. Participants: Thirty three patients with ischemic-related INO. Methods: Chart review of clinical details. Main Outcome Measure: Resolution of diplopia in primary position. Results: Of the group, 78.8% demonstrated resolution of diplopia in primary position with an average time to resolution of 2.25 months. The presence of associated neurologic symptoms (vertigo, ataxia, dysarthria, facial palsy, pyramidal tract signs) correlated with a worse prognosis for resolution of diplopia. When performed magnetic resonance imaging (MRI) demonstrated the causative infarct in only 52% of cases; the presence of an MRI-demonstrable lesion was not significantly associated with prognosis for resolution. Conclusions: Similar to ischemic ocular motor palsies, most ischemic-based INO become asymptomatic in primary position over 2 to 3 months. The presence of associated features correlated with persistent diplopia. MRI has limited yield in demonstrating the causative infarct.