Bilateral Pupil-Sparing Third Nerve Palsies as the Presenting Sign of Multiple Sclerosis

Abstract

We report the case of a young man who presented with bilateral third nerve palsies without pupillary involvement. Brain MRI demonstrated lesions in the region of the oculomotor nerves, and further evaluation led to the diagnosis of multiple sclerosis. Our case documents a rare initial clinical presentation of this demyelinating disease.

Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis

“…A similar constellation of symptoms (without optic neuritis) was reported in a 30-year-old man. 1 The crux to narrowing the wide differential diagnosis of bilateral ophthalmoplegia is anatomic localisation (Table 1). A focused history and ophthalmologic examination guides the diagnostic evaluation.…”

“…4 More recently, the first case of bilateral, pupil-sparing third nerve palsies as the presenting sign of adultonset MS was reported. 1 We present a case of a young girl presenting with bilateral, pupil-sparing, third nerve palsies as the presenting manifestation of paediatric MS. To our knowledge, this is the first paediatric case of its kind in the literature. The differential diagnosis and diagnostic workup for BLO 4 is updated to include advances in neuroimaging during the past two decades.…”

“…Isolated ocular motor nerve dysfunction as a presenting sign of multiple sclerosis (MS) is rare, 1,2 compared with nystagmus or internuclear ophthalmoplegia (INO). 3 Simultaneous bilateral mononeuropathies, regardless of the aetiology, are even more uncommon.…”