Unusual ocular motor findings in multiple sclerosis

Area of Science:

• Neurology
• Ophthalmology
• Neuroscience

Background:

• Multiple sclerosis (MS) commonly presents with ocular motor dysfunctions like nystagmus and internuclear ophthalmoplegia (INO).
• Focal brainstem lesions in MS can lead to rarer, complex ocular motor disturbances.
• These rare manifestations may include isolated ocular motor nerve palsies or more complex syndromes.

Purpose of the Study:

• To report and analyze unusual ocular motor disturbances in patients with multiple sclerosis.
• To correlate these rare clinical manifestations with neuroimaging findings, particularly MRI.
• To discuss the diagnostic and clinical implications of these complex symptoms in MS.

Main Methods:

• Case series involving five patients diagnosed with multiple sclerosis (MS).
• Comprehensive neuro-ophthalmological examinations and brain Magnetic Resonance Imaging (MRI) were conducted for all patients.
• Clinical presentations were correlated with MRI abnormalities, including gadolinium-enhanced and T2-weighted lesions.

Main Results:

• Five MS patients presented with rare ocular motor disturbances: bilateral third nerve palsy (n=2), opsoclonus, Horner's syndrome, and one-and-a-half syndrome.
• Ocular motor symptoms occurred at various times after MS onset, with one case presenting as the initial manifestation.
• Brainstem lesions on MRI correlated with clinical findings in four out of five patients; opsoclonus case had no brainstem lesion.
• All patients showed partial or complete recovery following corticosteroid treatment.

Conclusions:

• Multiple sclerosis can manifest with rare and complex ocular motor symptoms beyond typical presentations.
• Neuroimaging, especially MRI, is crucial for correlating brainstem lesions with these unusual ocular motor disturbances.
• These findings expand the spectrum of neurological presentations in MS and underscore the importance of thorough neuro-ophthalmological assessment.