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Related Experiment Videos

Complete bilateral horizontal gaze paralysis disclosing multiple sclerosis.

D Milea1, M Napolitano, H Dechy

  • 1Department of Ophthalmology, Hôpital de la Pitié-Salpêtrière, Paris, France.

Journal of Neurology, Neurosurgery, and Psychiatry
|February 13, 2001
PubMed
Summary

Two women experienced sudden vision loss due to bilateral internuclear ophthalmoplegia, likely caused by multiple sclerosis. Symptoms gradually improved over weeks, indicating potential recovery from this neurological condition.

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Area of Science:

  • Neuro-ophthalmology
  • Neuroimaging
  • Demyelinating Diseases

Background:

  • Internuclear ophthalmoplegia (INO) is a rare condition affecting eye movement coordination.
  • Bilateral INO can indicate significant neurological compromise, often associated with demyelinating diseases like multiple sclerosis.
  • Understanding the precise neuroanatomical correlates of INO is crucial for diagnosis and prognosis.

Observation:

  • Two female patients presented with acute onset bilateral internuclear ophthalmoplegia.
  • Clinical progression involved horizontal gaze paralysis, with preserved convergence and vertical movements.
  • Cerebral MRI revealed small white matter lesions, including a specific bilateral lesion in the medial pontine tegmentum.

Findings:

  • The observed clinical syndrome correlated with bilateral lesions in the medial pontine tegmentum affecting the medial longitudinal fasciculus and adjacent structures.

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  • Recovery followed a specific pattern: initial improvement in adduction, followed by persistent abduction paresis, and eventual complete resolution.
  • The probable etiology in both cases was identified as multiple sclerosis.

    • Implications:

    • This case highlights the importance of detailed neuroimaging in diagnosing the cause of bilateral gaze abnormalities.
    • The findings support the understanding of the medial longitudinal fasciculus's role in conjugate gaze and the potential for recovery in demyelinating conditions.
    • Early recognition and management of multiple sclerosis-related ocular motility disorders are essential for patient outcomes.