Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2020 , Vol 11, Issue 3
Bilateral Internuclear Ophthalmoplegia As a First Presenting Sign of Multiple Sclerosis
Murat Alemdar1,Gökhan Koz2
1Sakarya University Faculty of Medicine, Department of Neurology, Sakarya, Turkey
2Sakarya University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Sakarya, Turkey
DOI : 10.31067/0.2020.305 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. Keywords : Internuclear ophthalmoplegia, diplopia, multiple sclerosis