A case of pure bilateral horizontal gaze palsy due to multiple sclerosis

Hatake, Seira; Sakamaki, Masanori; Mishina, Masayoshi; Kitazato, Minako; Goto, Shizuka; Nishiyama, Yasuhiro; Nagayama, Hiroshi; Kimura, Kazumi

doi:10.1111/ncn3.12395

Cited by 1 publication

(2 citation statements)

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“…Besides the esotropia, we did not observe any nystagmus or loss of saccadic eye movement in our patient, which in contrast, received 1000 mg/day IV methylprednisolone for 5 days, with plasma exchange therapy for another 5 days. [ 4 ]…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, horizontal gaze palsy due to abducens (CN VI) nucleus lesion is the most ocular motor nerve in MS, as reported in a few case reports. [ 4 5 6 7 ] However, oculomotor (CN III) involvement is less commonly reported in previous literature, and trochlear nerve involvement is rarely encountered. Isolated gaze palsies are rarely reported, commonly due to other lesions such as INO.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral horizontal gaze palsy as an initial presentation of a clinically isolated syndrome: A case report

Alnosair,

Alanazi,

Alhumaid

et al. 2023

Saudi Journal of Ophthalmology

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Multiple sclerosis (MS) is the most common demyelinating disease affecting the central nervous system. It has a wide range of manifestations and commonly affects the visual system. Many patients with MS report decreased vision, diplopia, nystagmus, and abnormal ocular motility. Nevertheless, bilateral horizontal gaze palsies are exceptionally rarely seen. We present the case of a 24-year-old female who came to our pediatric ophthalmology clinic complaining of bilateral horizontal gaze palsy, photophobia, and eye pain for 2 days. Although the patient had a family history of MS, there was no similar or previous complaint, with an unremarkable past medical and surgical history. During the examination, she was found to have a complete bilateral absence of horizontal saccade and pursuit, with slight limitations in vertical ones. There was no nystagmus or skew deviation, and the rest of the cranial nerves (CNs) were intact. Her ocular vital signs were normal, and her corrected visual acuity was 20/20 with full-color vision. The rest of the physical and neurological examinations were unremarkable. After referral to neurology, the magnetic resonance imaging showed multiple hyperintense lesions in deep white matter, pons, and midbrain. The correlation of imaging findings with clinical presentation confirmed the diagnosis of a clinically isolated syndrome. Extra-ocular motility (EOM) significantly improved after pulse steroid therapy and five sessions of plasma exchange, but the patient developed 35 prism diopter of acquired concomitant esotropia. She underwent a right medial rectus botulinum toxin injection which dramatically improved her condition, and became orthotropic during the last 2 months of follow-up after the injection.

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Section: Discussionmentioning

confidence: 99%