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Images in Neurology
May 2010

Wall-Eyed Bilateral Internuclear Ophthalmoplegia After Ruptured Aneurysm

Author Affiliations

Author Affiliations: Departments of Neurologic Surgery (Drs Jacob and Lanzino) and Neurology, Division of Critical Care Neurology (Drs Burns, Dupont, and Wijdicks), Mayo Clinic, Rochester, Minnesota.

Arch Neurol. 2010;67(5):636-637. doi:10.1001/archneurol.2010.60

A 67-year-old man was found comatose after subarachnoid hemorrhage from rerupture of a previously clipped anterior communicating artery aneurysm. He had no motor response and no eye opening in response to pain. Corneal, cough, and pupil reflexes were intact. Initially he had forced downward gaze with small reactive pupils that evolved in a matter of hours to an extreme exotropia of both eyes that persisted for days (Figure 1). Oculovestibular responses to cold caloric stimulation were absent.