As the first sign of multiple sclerosis, eight-and-a-half syndrome

Excerpt

A 47-year-old-woman presented with diplopia looking to right side and dizziness for a week. The patient also had a vertigo attack for 2 days long, 2 years ago. She had diabetes mellitus and hypertension in medical history. Ocular motor examination disclosed total conjugate gaze palsy to left (Fig. 1a) and left internuclear ophthalmoplegia (Fig. 1b) suggestive of one-and-a-half syndrome. She also had left peripheric facial palsy (Fig. 1c). Motor, sensory, and cerebellar system examinations and deep tendon reflexes were normal. Brain MRI revealed multiple periventricular, cerebellar, medullary, and pontine white matter demyelination lesions and contrast enhancement at pons (Fig. 2a–d). Cerebrospinal fluid investigation showed normal protein (23.3 mg/dl) and glucose (91 mg/dl) level. Oligoclonal band was positive and IgG index was 0.8. The patient was diagnosed with multiple sclerosis. After 7-day pulse steroid treatment, her complaints regressed and interferon beta-1a regimen was recommended.

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