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Ocular neuromyotonia secondary to a cavernous sinus meningioma

Transient diplopia is a common presenting complaint in ophthalmology and neurology clinics. Ocular neuromyotonia (ONM) is a rare cause of transient diplopia and is diagnosed thorough clinical examination, using specific maneuvers to trigger intermittent spasms. We describe a case of left ONM, secondary to ipsilateral cavernous sinus meningioma.

A 41-year-old previously well woman had episodes of recurrent binocular diplopia for 1 year. These episodes lasted 10 to 20 seconds, occurred 5 to 10 times a day, and were triggered by specific eye movements. She had paroxysmal electrical discharges in the ophthalmic division of the left trigeminal nerve. Examination showed mild proptosis, slight ptosis, and a mild supraduction deficit of the left eye. Diplopia was elicited only after 15 seconds of sustained extreme gaze (see the video, on the Neurology Web site at www.neurology.org). Sustained up gaze triggered retraction of the left upper eyelid, most marked in down gaze. Following sustained right gaze, on attempted …