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A 20-year-old woman with abnormal eye movements
Digital Journal of Ophthalmology 2021
Volume 27, Number 1
January 4, 2021
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Vivian Paraskevi Douglas, MD, DVM, MBA | Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
Homer H. Chiang, MD | Department of Ophthalmology, UT Health San Antonio, San Antonio, Texas
Konstantinos A. A. Douglas, MD, DVM, MBA | Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
Tavé Van Zyl, MD | Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
Nurhan Torun, MD | Division of Ophthalmology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Ancillary Testing
Magnetic resonance imaging (MRI) of the brain revealed a brainstem cavernous malformation. T1- and T2-weighted MRI demonstrated a “popcorn” hyperintensity in the left posterior pons, with adjacent hypointensities anterior and anteromedial to the lesion, consistent with remote hemorrhage (Figure 2). Given our patient’s historical complaint, the oblique diplopia was thought to reflect a skew deviation rather than trochlear nerve involvement. In such a scenario, however, cessation of bleeding and clearance of blood products would have generally allowed neural tissue far from the center of the lesion to regain function.
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Figure 2
T1-weighted axial magnetic resonance imaging demonstrating a “popcorn” hyperintensity in the left posterior pons, with adjacent hypointensities anterior and anteromedial to the lesion consistent with remote hemorrhage, all in keeping with left pontine cavernous malformation.