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Neurological picture
Isolated myositis of the superior oblique muscle
  1. Robert Fleischmann1,
  2. Anke Assmann2,
  3. Georg Bohner3,
  4. Klemens Ruprecht1
  1. 1Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
  2. 2Department of Gastroenterology, Nephrology, and Lipidology, Charité—Universitätsmedizin Berlin, Berlin, Germany
  3. 3Department of Neuroradiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Klemens Ruprecht, Department of Neurology, Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany; klemens.ruprecht{at}charite.de

https://doi.org/10.1136/jnnp-2012-303796

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    A 34-year-old woman presented with a 10 day history of right-sided throbbing headaches and right retro-orbital pain with subacute onset. On the day of admission, she had additionally noticed binocular diplopia when looking upwards. Her past medical history was unremarkable, in particular, she had no recurrent headaches or ocular disease. Neurological examination revealed a mildly impaired elevation of the right eye which was more pronounced on adduction than on abduction. Accordingly, the patient reported vertical oblique diplopia on upward gaze that was more prominent on leftward than on rightward upgaze. The remainder of the neurological examination was normal. There were no conjunctival injection, eyelid swelling or proptosis, and an ophthalmological examination performed 2 days before admission was normal. MRI …

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    Footnotes

    • Contributors RF and KR wrote the manuscript. RF, AA, GB and KR were involved in clinical evaluation and patient management. All authors reviewed and approved the final version of the manuscript.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.