Clinical Reasoning: A 12-Year-Old Girl With Acute-Onset Diplopia, Dizziness, and Upbeat Nystagmus

We report a case of a 12-year-old girl who presented with acute-onset diplopia, dizziness, and upbeat nystagmus. On examination, she had right internuclear ophthalmoplegia with right eye hypertropia and exotropia and impaired convergence. In addition, she also had spontaneous primary position symmetric upbeat nystagmus. In this report, we discuss the clinical approach with meticulous neuro-ophthalmologic examination and neuroanatomic localization in pediatric patients with acute-onset diplopia.