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October 1997

Ocular Neuromyotonia 18 Years After Radiation Therapy

Author Affiliations

Atlanta, Ga

Arch Ophthalmol. 1997;115(10):1331-1332. doi:10.1001/archopht.1997.01100160501026

Report of a Case.  The patient is a 33-year-old woman. At age 6 years she underwent partial resection of a cerebellar ependymoma followed by radiation therapy to the spinal axis (27 Gy) and placement of a ventriculoperitoneal shunt. She had no visual symptoms until 18 years later, when she noted occasional horizontal diplopia. Neuro-ophthalmologic evaluation results revealed a variable horizontal esotropia that possibly responded to the administration of edrophonium chloride (Tensilon, ICN Pharmaceuticals, Costa Mesa, Calif). Electromyography and nerve conduction study results were normal. The patient's condition was initially diagnosed as ocular myasthenia gravis and she began receiving pyridostigmine bromide therapy, without improvement. Her symptoms remained stable for the next 8 years without any further ocular or systemic symptoms consistent with myasthenia gravis.On her first visit to our institution, 27 years after treatment for cerebellar ependymoma, neuroophthalmologic examination results were normal except for ocular motility. Ductions and versions were

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