Great videos! Thank you Dr Lee. Any chance you would consider doing a video on the difference between Lambert-Eaton Syndrome and Myasthenia Gravis, and clinical findings to help tell the difference? Thanks for your willingness to educate!
Here are the first things that come to mind, MG is caused by antibodies that attack the postsynaptic nicotinic acetylcholine receptors, while in LES there’s antibodies that attack the presynaptic voltage gated Ca channels. Clinically, recurrent nerve stimulation in MG leads to exhaustion of the muscle, manifested by weakness while in LES there’s improvement following stimulation. This is why patients in MG feel weaker during exercise but in LES they feel better.
Hi Dr. Lee! 2 quick questions: 1. How would you differentiate between a EBINO and bilateral medial rectus palsy? 2. Can you have EBINO without nystagmus?
Sir I understand why Adductor Palsy or Diplopia or Nystagmus is happening, but I still cant understand why/how we are getting "Walled Eye" in B/L INO??
If the lesion is in the upper medial midbrain, it takes out both medial rectus subnuclei on both sides (found close to each other), which leads to unopposed action of the lateral rectus bilaterally, which 'pulls' both eyes out as there are not opposiing medial forces to bring the eye in. This creates the 'walled eyed' appearance. If it helps, I have a video on my channel titled INO syndromes that goes through this in detail. Hope this helps.
