In a patient with strabismus without cranial nerve stigmata, what is likely the cause?

In a case of strabismus that does not involve cranial nerve stigmata, the most likely cause is related to the involvement of the visual cortex. Strabismus, often referred to as "crossed eyes," occurs when the eyes do not properly align with each other, which can result from several factors, including disruptions in the coordination of the brain's visual pathways.

When the visual cortex is involved, it can affect how the brain processes and integrates visual information from both eyes. This can lead to a lack of proper ocular alignment without direct involvement of the cranial nerves that innervate the extraocular muscles. The visual cortex plays a crucial role in eye movement control and proper binocular vision. When there is impaired function or development in this area, it can lead to misalignment of the gaze, resulting in strabismus.

In contrast, incorrect eye muscle strength typically points to mechanical issues with the muscles themselves rather than a cortical issue. Similarly, an imbalance of intraocular pressure does not directly create strabismus; it is more related to conditions such as glaucoma or other eye disorders. Finally, while cranial nerve palsy is a possible cause of strabismus, the question specifies that there are no cranial nerve stigmata