Case Report: Bilateral Horizontal Gaze Palsy (1 + 1 Syndrome): A Supranuclear Gaze Palsy

Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report

Introduction

Multiple sclerosis (MS) is a demyelinating condition of the central nervous system (CNS) that primarily affects young adults. Very late-onset multiple sclerosis (VLOMS) is an uncommon form of MS, accounting for only 0.5 percent of all MS patients. Eye movement impairments such as internuclear ophthalmoplegia are common in MS, while horizontal gaze palsy is an uncommon occurrence.

Case Presentation

We report a case of a patient diagnosed with VLOMS who presented with left horizontal gaze palsy and ipsilateral facial nerve palsy. Brain magnetic resonance imaging showed Dawson's fingers in the left and right periventricular white matter; multiple small, round, hyperintense lesions in the left and right cortex and juxtacortical cerebellar hemisphere; and small hyperintense lesion in the left paramedian pontine reticular formation, suggesting the diagnosis of MS. Oral corticosteroids led to complete resolution of ocular movement and ipsilateral facial nerve palsy.

Conclusion

We propose that neuroimaging should be performed in ophthalmoplegia with a pattern representing CNS lesion and oral corticosteroids may be an effective alternative to high-cost intravenous corticosteroids.

A case of bilateral horizontal gaze palsy and concurrent esotropia

Purpose

To report a unique case of bilateral horizontal pontine gaze palsy with concurrent esotropia, surgical management, and post-operative follow-up.

Observations

A 39-year-old male presented with diplopia and a history of neurocysticercosis. He was found to have bilateral horizontal gaze palsy and concurrent esotropia, R > L. Classic bimedial rectus recess-resect surgery was done to include resection of the right lateral rectus muscle. Follow-up three months post-op demonstrates markedly improved diplopia.

Conclusion and importance

We present a recommended therapeutic approach for the rare case of concurrent bilateral horizontal gaze palsy and esotropia, which should be further evaluated in longitudinal studies.