Functional convergence spasm in a patient with headache and diplopia: A case report

Abstract

Introduction

The convergence spasm is characterized by intermittent episodes of sustained maximal convergence, miosis, and accommodative spasm with associated disconjugate gaze that mimic sixth cranial nerve palsy. Most of these cases are functional. We describe a patient with a diagnosis of convergence spasm in a patient experiencing persistent headache and diplopia.

Case presentation

A 35-year-old woman came for the assessment of a persistent headache and diplopia. Examination revealed brief episodes (∼10–30 seconds)) of convergent strabismus mimicking sixth cranial nerve palsy. A comprehensive workup including lumbar puncture and MRI scans was initiated. Normal findings prompted holistic management, including Paracetamol, SSRIs, and counseling, resulting in significant clinical improvement within a very short timeframe.

Discussion

In order to rule out organic causes, functional disorders such as convergence spasm frequently require thorough studies; however, it is crucial to identify psychosocial stressors. The significance of psychiatric evaluation and early diagnosis of functional etiologies is highlighted by a case, a 28-year-old female with diplopia who improved after being reassured. The same approach improved our patient’s neurological symptoms. A multidisciplinary strategy that combines medical and psychological support works well.

Conclusion

This case highlights the complex presentation of convergence spasm, manifesting as persistent headache and diplopia. Clinicians should thoroughly investigate functional etiologies in such cases.