Abstract
Internuclear ophthalmoplegia is a disorder of conjugate horizontal gaze in which the affected eye shows impairment of adduction and contralateral eye abducts with nystagmus. Internuclear ophthalmoplegia is caused by disruption of the medial longitudinal fasciculus which connects the nucleus of sixth cranial nerve on one side of the pons to the medial rectus subnucleus of the third cranial nerve in the contralateral midbrain. Bilateral internuclear ophthalmoplegia due to brainstem lesions is rarely seen in clinical practice. Herein, we present a 40-year-old female who was diagnosed with multiple sclerosis after she experienced her first attack with diplopia due to bilateral internuclear ophthalmoplegia. The clinical history of the presented case revealed clearly that multiple sclerosis should be highly suspected in patients admitted to emergency rooms with diplopia, particularly in cases presenting with bilateral internuclear ophthalmoplegia. The patients with internuclear ophthalmoplegia should be searched with brain and brainstem magnetic resonance imaging
References
- Serra A, Chisari CG, Matta M. Eye Movement Abnormalities in Multiple Sclerosis: Pathogenesis, Modeling, and Treatment. Front Neurol 2018;9:31. [CrossRef]
- Obuchowska I, Mariak Z. Internuclear ophthalmoplegia --causes, symptoms and management. Klin Oczna 2009;111:165–7.
- Wu YT, Cafiero-Chin M, Marques C. Wall-eyed bilateral internuclear ophthalmoplegia: review of pathogenesis, diagnosis, prognosis and management. Clin Exp Optom 2015;98:25–30. [CrossRef ]
- Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S. The neuro- ophthalmology of multiple sclerosis. Lancet Neurol 2005;4:111–21. [CrossRef]
- Nerrant E, Tilikete C. Ocular Motor Manifestations of Multiple Sclerosis. J Neuroophthalmol 2017;37:332–340. [CrossRef]
- Tsuda H, Ishikawa H, Matsunaga H, Mizutani T. A neuro- ophthalmological analysis in 80 cases of multiple sclerosis. Rinsho Shinkeigaku 2004;44:513–21.
- Sarıçam G, Dirik EB, Akyol S, Anlar O. Bilateral internuclear ophthalmoplegia in myasthenia graves. Turk J Neurol 2018;24:90–1. [CrossRef]
Abstract
İnternükleer oftalmopleji; etkilenen taraftaki göz küresinde addüksyon kusuru ve karşı taraf göz küresinde abdüksiyon esnasında nistagmusun oluştuğu bir konjüge horizontal bakış bozukluğudur. İnternükleer oftalmopleji ponsun bir yarımındaki altıncı kraniyel sinir çekirdeğinin karşı taraf mezensefalondaki üçüncü kraniyel sinir alt çekirdeğiyle iletişimini sağlayan medial longitüdinal fasiküldeki bozukluktan kaynaklanır. Beyinsapı lezyonlarına ikincil bilateral İnternükleer oftalmopleji klinik pratikte nadir görülür. Burada, ilk atağını bilateral internükleer oftalmoplejiye bağlı diplopiyle geçirmesi sonrası multipl skleroz tanısı alan 40 yaşındaki bir kadın olgu sunmaktayız. Sunulan hastanın klinik öyküsü, acil servislere diplopi ile başvuran, özellikle bilateral internükleer oftalmoplejiyle prezente olan olgularda multipl skleroz tanısından şüphenilmesi gerektiğini açıkça ortaya koymaktadır. İnternükleer oftalmoplejili olgular beyin ve beyinsapına yönelik manyetik rezonans görüntülemeleriyle incelenmelidir
References
- Serra A, Chisari CG, Matta M. Eye Movement Abnormalities in Multiple Sclerosis: Pathogenesis, Modeling, and Treatment. Front Neurol 2018;9:31. [CrossRef]
- Obuchowska I, Mariak Z. Internuclear ophthalmoplegia --causes, symptoms and management. Klin Oczna 2009;111:165–7.
- Wu YT, Cafiero-Chin M, Marques C. Wall-eyed bilateral internuclear ophthalmoplegia: review of pathogenesis, diagnosis, prognosis and management. Clin Exp Optom 2015;98:25–30. [CrossRef ]
- Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S. The neuro- ophthalmology of multiple sclerosis. Lancet Neurol 2005;4:111–21. [CrossRef]
- Nerrant E, Tilikete C. Ocular Motor Manifestations of Multiple Sclerosis. J Neuroophthalmol 2017;37:332–340. [CrossRef]
- Tsuda H, Ishikawa H, Matsunaga H, Mizutani T. A neuro- ophthalmological analysis in 80 cases of multiple sclerosis. Rinsho Shinkeigaku 2004;44:513–21.
- Sarıçam G, Dirik EB, Akyol S, Anlar O. Bilateral internuclear ophthalmoplegia in myasthenia graves. Turk J Neurol 2018;24:90–1. [CrossRef]
Details
| Primary Language | English |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | September 1, 2020 |
| Published in Issue | Year 2020Issue: 3 |