FP5

When the Eyes Reveal the Stroke: Internuclear Ophthalmoplegia(INO) Following Percutaneous Transluminal Coronary Angioplasty (PTCA)

Purpose:To report a rare case of unilateral INO following PTCA.

Case Report: A 50year hypertensive woman with NSTEMI underwent PTCA to the right coronary and left anterior descending arteries. Within hours, she developed sudden binocular diplopia. Best-corrected visual acuity was 6/6 in both eyes. Ocular motility showed impaired adduction of the right eye with abducting nystagmus of the left eye, consistent with right INO. MRI brain demonstrated acute infarction involving the right medial longitudinal fasciculus in the periaqueductal midbrain with an associated right parietal infarct, confirming procedural embolic ischemic stroke. Conservative management resulted in partial improvement within one week and near-complete recovery by 4–6 weeks.

Conclusion :INO is a rare neuro-ophthalmic manifestation of post-PTCA embolic stroke. Prompt ocular motility examination and neuroimaging enable early diagnosis and appropriate management, with generally favourable recovery.