Título

FOURTH CRANIAL NERVE PALSY AND INTERNUCLEAR OPHTHALMOPLEGIA AS AN EARLY PRESENTATION OF MULTIPLE SCLEROSIS – A CASE REPORT

Introdução

Internuclear ophthalmoplegia (INO) is a rare ophthalmological condition, being caused by lesions in the medial longitudinal fascicle, often related to vascular, tumoral or demyelinating etiologies. The clinical finding of defective adduction ipsilateral to the lesion with preserved convergence is typical.
The present case report refers to a previously healthy male patient who presented with INO associated with contralateral fourth cranial nerve palsy and was later diagnosed with multiple sclerosis due to ocular findings and associated complaints.

Métodos

Case report

Resultados

Infectious etiologies were excluded and with the main diagnostic hypothesis being of right fourth cranial nerve palsy associated with left INO due to left midbrain demyelination, pulse therapy with one gram of methylprednisolone was indicated for three days, and the patient was referred to our neuro-ophthalmology department as well as our demyelinating disease sector.

Conclusões

Patients presenting INO deserves a careful history and physical examination, as well as investigation with laboratory and imaging tests, due to the severity of its main etiologies³.
Our patient is an example that we cannot rely on epidemiology alone when conducting a diagnostic investigation. Although multiple sclerosis is a more prevalent disease in young women, it can never be ruled out without proper examinations⁴.
One interesting aspect about the reported case is that the mutual involvement of the fourth cranial nerve helps to topograph the site of the lesion, so that the imaging is merely a confirmatory exam.

Palavras Chave

Internuclear Ophthalmoplegia, multiple sclerosis

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