Case Studies in Ophthalmology
Cases for the Ophthalmology Clerkship
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Case #51 Internuclear Ophthalmoplegia
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.