This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on Web of Science (1)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Neuro-ophthalmology  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 142 words of the full text and any section headings.

We read with interest the article by Dr Keane on internuclear ophthalmoplegia (INO). There is an area of doubt concerning the exact focus of neurologic damage in the enrolled INO cases about which we would like to learn more from the author.

Medial rectus limitation or slowing, dissociated nystagmus and preserved convergence are deemed as the essential components of INO due to medial longitudinal fasciculus damage.¹ However, the adduction palsies seen in INO are not unique and can be mimicked by adduction defect due to infranuclear ophthalmoplegia.² The only clinical checkpoint that can distinguish these 2 is the recognition of an impaired vertical vestibulo-ocular reflex.² Perhaps Dr Keane can enlighten us further with respect to this query.

AUTHOR INFORMATION

Correspondence: Dr Liu, Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR (david_tlliu@yahoo.com).

David T. L. Liu, MRCS; Chi-Lai Li, MRCS; Vincent Y. W. Lee, FRCS

1. Keane JR. Internuclear ophthalmoplegia: unusual causes in 114 of 410 patients. Arch Neurol. 2005;62:714-717. FREE FULL TEXT 2. Ranalli PJ, Sharpe JA. Vertical vestibule-ocular reflex, smooth pursuit and eye-head tracking dysfunction in internuclear ophthalmoplegia. Brain. 1988;111:1299-1317. FREE FULL TEXT

Arch Neurol. 2006;63:626.

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