Oculomotor nerve palsy as an initial manifestation of multiple sclerosis: Case report

Authors

DOI:

https://doi.org/10.33448/rsd-v11i10.33205

Keywords:

Multiple esclerosis; Strabismus; Oculomotor nerve diseases.

Abstract

Objective: To report a case of multiple esclerosis with an atypical manifestation in terms of initial signs and symptoms, age group and gender. Methodology: Case report based on the medical Record of a patient who whas hospitalized at the Hospital Policlínica de Pato Branco, in the municipality of Pato Branco, Paraná, due to a unilateral oculomotor nerve paralysis, subsequently diagnosed with multiple sclerosis. Case description and discussion: The afore mentioned case started with convergente strabism, diplopia and palpebral ptosis, in the right eye, characterizing paralisy of the III cranial nerve on the right, without other associated signs or sympotms. Investigation by magnetic ressonance and CSF analysis was performed. Multiple sclerosis is a demyelinating disease that impairs the transmission of nerve impulses, resulting in the most diversal clinical manifestations, according to the area of the central nerbous system that is affected and affects mainly young and white womem, between the thurd and fourth decades of life, typically starting with an acute or subacute picture of visual sensivity changes. Conclusion: Adding the clicinal findings to the complementary exams, it was possible to infer the diagnosis of multiple sclerosis, even being a patient with atypical atypical manifestation in terms of initial signs and symptoms, age group and gender.

References

Adam, M. K., Krespan, K., Moster, M. L., & Sergott, R. C. (2014). Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis. Neuroophthlamology, 38(4), pp. 230-237. 10.3109/01658107.2014.902972

Beleza, P., Machado, Á., Soares-Fernandes, J., Carneiro, G., Jordão, M. J., Almeida, F., & Figueiredo, J. (2008). Isolated oculomotor nerve paresis as the presenting sign of multiple sclerosis. Arquivos de Neuro-Psiquiatria, 66(2a), 254-255.10.1590/S0004-282X2008000200024

Bentley, P. I., Kimber, T., & Schapira, A. H. (2002). Painful third nerve palsy in MS. Neurology, 58(10), 1532.10.1212/wnl.58.10.1532

Besharati, M. R., Hoseinzadeh, A., Yazdian-Anari, P., Aliabadi, S. G., Vaghefi, M., & Mansouri, M. (2015). Determining the Frequency Distribution of Ocular Manifestations in Multiple Sclerosis Patients. International Journal of Travel Medicine and Global Health, 3(2), 71-74.10.20286/ijtmgh-030280

Bhatti, M. T., Schmalfuss, I. M., Williams, L. S., & Quisling, R. G. (2003). Peripheral Third Cranial Nerve Enhancement in Multiple Sclerosis. AJNR Am J Neuroradiol, 24(7), pp. 1390-1395.

Costin, D., Pinzaru, G. M., Pătraşcu, A. M., & Moţoc, A. (2018). Multiple sclerosis with ophthalmologic onset - case report. Romanian Journal of Ophthalmology, 62(1), 78-82.10.22336/rjo.2018.11

Estrela, C. (2018). Metodologia científica: Ciência, ensino, pesquisa. (3ª edição): Artes médicas

Goldim, J. R. (2004). Princípios éticos. Fonte: https://www.ufrgs.br/bioetica/princip.htm#beauchamp. Acesso em: 02 jul. 2022.

Goldman, L., & Ausiello, D. (2009). Cecil Medicina. Elsevier.

Guyton, A. C., & Hall, J. E. (2011). Tratado de Fisiologia Médica. Elsevier.

Longo, D. L. (2013). Medicina Interna de Harrison. AMGH.

Modi, P., & Arsiwalla., T. (2022). Cranial Nerve III Palsy. StatPearls [Internet].

Pereira, C. U., Santos, A. C., Júnior, J. A., Campos, G. J., Carvalho, R. W., & Gusmão, L. C. (2012). Nervo Oculomotor: Anatomia, Fisiologia e Clínica. Rev. cir. traumatol. buco-maxilo-fac, 12(2), 93-104.

Roodhooft, J. M. (2012). Summary of eye examinations of 284 patients with multiple sclerosis. Int J MS Care, 14(1), 31-38.https://doi.org/10.7224/1537-2073-14.1.31

Sibinelli, M. A., Cohen, R., Ramalho, A. M., Tilbery, C. P., & Lake, J. C. (2000). Manifestações oculares em pacientes com esclerose múltipla em São Paulo. Arquivos Brasileiros de Oftalmologia, 4, 287-291.10.1590/S0004-27492000000400009

Taksande, A., Meshram, R., & Lohakare, A. (2017). A Rare Presentation of Isolated Oculomotor Nerve Palsy due to Multiple Sclerosis in a Child. International Journal of the Pediatrics, 5(8), 5525-5529. 10.22038/ijp.2017.24602.2075

Thömke, F., Lensch, E., Ringel, K., & Hopf, H. C. (1997). Isolated cranial nerve palsies in multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry, 63(1), 682-685.10.1136/jnnp.63.5.682

Visaria, J., Thomas, N., Gu, T., Singer, J., & Tan, H. (2018). Understanding the Patient's Journey in the Diagnosis and Treatment of Multiple Sclerosis in Clinical Practice. Clin Ther., 40(6), 926-939. 10.1016/j.clinthera.2018.04.019

Published

07/08/2022

How to Cite

OLIVEIRA, C. S. de; BASTIANI, F. G. de .; RODRIGUES, C. F. A. Oculomotor nerve palsy as an initial manifestation of multiple sclerosis: Case report. Research, Society and Development, [S. l.], v. 11, n. 10, p. e475111033205, 2022. DOI: 10.33448/rsd-v11i10.33205. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/33205. Acesso em: 22 nov. 2024.

Issue

Section

Health Sciences