Brain MRI in Multiple Sclerosis (Guest Lecture)

The patient is a 25 year old woman who was in excellent health until 4 days prior to admission when she noted blurred vision and horizontal double vision on lateral gaze to right and left. Past History: Negative for strabismus as a child. No previous episodes of transient neurological symptoms. Family History: Negative for neurological diseases. Neuro-ophthalmological Examination Visual acuity 20/20 OU Visual fields, pupils and fundus examination normal. Ocular Motility: Paresis of adduction of the right eye on gaze left Abducting nystagmus of the left eye on gaze left. Paresis of adduction of the left eye on gaze right Abducting nystagmus of the right eye on gaze right Normal convergence Upbeat nystagmus on upgaze Downbeat nystagmus on downgaze Saccadic dysmetria Hypermetria of the adducting eye Hypometria of the abducting eye Diagnosis: Bilateral internuclear ophthalmoplegia (INO) Saccadic dysmetria Brain CT with and without contrast normal. Prognosis: On follow-up six weeks later the eye movements were normal. Diagnosis: Multiple Sclerosis (MS) The diagnosis of MS was suspected and discussed with the patient and her parents. The rapid recovery of her motility disorder was consistent with the diagnosis. MS is the commonest cause of a bilateral internuclear ophthalmoplegia in a young adult. Brainstem infarction is the commonest cause of a unilateral internuclear ophthalmoplegia in middle aged and elderly adults. A bilateral internuclear ophthalmoplegia in a child raises the possibility of a 4th ventricle tumor. (ID163-6). The patient is a little boy who presented with a bilateral INO and was found to have a medulloblastoma. See also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/94