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Post-traumatic spasticity — SCE Neurology MCQ

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HardNeurorehabilitationPost-traumatic spasticitySCE Neurology

A 57-year-old treated with sellar radiotherapy 12 years ago has seconds-long attacks of horizontal diplopia. Sustained right gaze reproducibly triggers a tonic left medial-rectus contraction that slowly relaxes; examination between attacks is normal. What is the most likely diagnosis?

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Correct answer: A — Ocular neuromyotonia

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

D is correct: ocular neuromyotonia causes brief, recurrent tonic extraocular-muscle spasms, often triggered by eccentric gaze and associated with previous cranial irradiation or nerve compression. Ocular myasthenia causes fatigable weakness rather than a reproducible tonic spasm. Superior oblique myokymia causes very brief torsional monocular oscillations. Internuclear ophthalmoplegia is a persistent adduction deficit with abducting nystagmus, not a paroxysmal contraction.

Reference: Neuromuscular junction disorders: mimics and chameleons: https://pn.bmj.com/content/24/6/467