Case #51 Internuclear Ophthalmoplegia

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History

A 30 year old woman with a history of optic neuritis at age 24 developed horizontal diplopia. She is able to abduct both eyes but cannot fully adduct either eye. There is a mild vertical divergence (skew deviations).

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Question #1

What is the likelihood of developing multiple sclerosis after a bout of optic neuritis?

Question #2

Other than M.S., what conditions could cause bilateral internuclear ophthalmoplegia?

Question #3

What tests should be done to establish the diagnosis fo M.S.?

Question #4

At this stage would she have possible, probable or definite M.S.?

Question #5

Where in the brain is the lesion responsible for her internuclear ophthalmoplegia?

References

Rizzo JF, Lessell S: Risk of developing multiple sclerosis after uncomplicated optic neuritis: A long-term prospective study. Neurology 1988; 38:185.

Gonyea EF: Bilateral internuclear ophthalmoplegia. Arch Neurol 1974;31:168.

Cogan DG: Bilateral internuclear ophthalmoplegia. Arch Ophthalmol 1970; 84:583.

Matthews WB, et al. McAlpine’s Multiple Sclerosis. Churchill Livingstone, New York, 1985.

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last updated: 10/10/2011