EpistemisInternuclear ophthalmoplegia
Specialty: Neurology.
Why it occurs
- Multiple sclerosis (main cause in young patients, frequently bilateral due to demyelinating plaque in the brain stem)
- Ischemic stroke of perforating branches of the basilar artery (main cause in elderly patients, typically unilateral)
- Brain stem tumors (pontine gliomas)
- Acute disseminated encephalomyelitis (ADEM)
- Brain stem infections (neurosyphilis, listeriosis)
Initial workup
Examination of lateral conjugate gaze showing the inability to adduct the eye ipsilateral to the lesion in the medial longitudinal fasciculus, accompanied by abduction nystagmus in the contralateral eye; high-resolution brain MRI focusing on the pons and posterior midbrain (T2, FLAIR, and diffusion sequences); Lumbar puncture for CSF analysis if multiple sclerosis or infectious origin is suspected.
red flags
Acute internuclear ophthalmoplegia associated with contralateral hemiparesis or hemihypoesthesia, severe dysarthria, progressive dysphagia or facial paralysis, suggestive of acute pontine infarction due to occlusion of the basilar artery (code posterior fossa stroke).
Standard management
- Intravenous methylprednisolone — 1000 mg daily for 3-5 days if multiple sclerosis outbreak is confirmed
- Antiaggregation or platelet anticoagulation depending on the origin of the ischemic stroke detected.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 2