Magnetic Resonance Imaging (MRI) in Multiple Sclerosis

M.L., a 45-year-old man, experienced the abrupt onset of vertical diplopia in January 1984 and has remained unchanged since that time. It is present primarily on left lateral gaze, more when looking down and to the left than up and to the left. He struck the top of his head hard against a steel door frame about two months before. When that occurred, he was surprised and hurt, but said that he was not stunned and did not develop a headache. His past medical history includes recurrent migrainous headaches since childhood which occur roughly once a month and sometimes are associated with nausea and vomiting. He has not had visual or other neurologic symptoms with them. The headaches are often right occipital and throbbing. Hypertension was discovered several years ago, and Jed to treatment with Lopressor, 50 mg p.o. daily. His mother has headaches.