J Neurol Neurosurg Psychiatry 84:587 doi:10.1136/jnnp-2012-304796
  • Neurological picture

The chameleon syndrome: acute convergence paralysis

  1. Jose Antonio Egido
  1. Stroke Unit, Hospital Clínico Universitario San Carlos, Madrid, Spain
  1. Correspondence to Dr Jose Antonio Egido, Stroke Unit, Hospital Clínico Universitario San Carlos, Avda/Martín Lagos s/n, Madrid 28040, Spain; jegidoh{at}
  • Received 18 December 2012
  • Revised 10 January 2013
  • Accepted 14 January 2013
  • Published Online First 14 February 2013

A 78-year-old female patient without vascular risk factors presented with sudden left eye deviation at awakening. Neither diplopia nor other symptoms were reported. On admission, left eye exotropia at primary gaze position and bilateral internuclear ophthalmoplegia (bINO) were found (figure 1A,B). Convergence in the near sight was impossible. Vertical conjugate gaze was flawless. Visual acuity was normal in both eyes. Cover–uncover test (see online supplementary video) was performed. Strabismus disappeared after 1 week.

Figure 1

(A) …

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