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Published on: July 22, 2014
MRI-Negative Internuclear Ophthalmoplegia: A Diagnostic Challenge Emphasizing Clinical Localization
Moataz Mohamed1,2, Abdulaziz Alharbi3, Rahmah Alanazi4
1General Medicine, Al Ribat National University, Khartoum, SDN.
Cureus
|June 9, 2026
Summary
Internuclear ophthalmoplegia (INO) can be challenging to diagnose with MRI due to small lesions. Pathognomonic physical findings are crucial for diagnosing this ocular motility disorder, especially in pediatric demyelinating events.
Area of Science:
- Neurology
- Ophthalmology
- Neuroimaging
Background:
- Internuclear ophthalmoplegia (INO) is an ocular motility disorder affecting the medial longitudinal fasciculus (MLF).
- Small inflammatory lesions in the MLF may not be detected by standard MRI (1.5T or 3T), causing clinical-radiographic dissociation.
- This dissociation presents a diagnostic challenge, particularly when physical findings are conclusive despite negative neuroimaging.
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