Videonystagmography in bilateral Internuclear Ophthalmoplegia. Case report and review of the literature

Abstract

Internuclear ophthalmoplegia is caused by disruption of the medial longitudinal fasciculus. It is characterized by a paresis of the adduction of the affected eye and abduction nystagmus of the contralateral eye. It has been reported in 35 to 53% of those patients with multiple sclerosis and in young people may be bilateral. A systematic examination of eye movements shows a range of disorders. Videonystagmography can detect subtle ocular motility abnormalities due to connections with the vestibular apparatus. We present the case of a 37-year-old man with bilateral internuclear ophthalmoplegia secondary multiple sclerosis. The vestibulometric data were performed and analyzed, both qualitatively and quantitatively. Each eye was recorded separately. The oculomotor alterations were detected. Studies have suggested that internuclear ophthalmoplegia is missed by 71% of physicians unaided by quantitative oculomotor testing. At the same time, the importance of the video-nystagmographical system was stressed to the extent that it leads to a standardised and objective analysis fundamental for clinical aspects.