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Year : 2022  |  Volume : 34  |  Issue : 2  |  Page : 191

Atypical presentation of multiple sclerosis – A few points to ponder

Department of Ophthalmology, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Submission14-Jul-2022
Date of Decision20-Jul-2022
Date of Acceptance13-Aug-2022
Date of Web Publication30-Aug-2022

Correspondence Address:
Dr. Anisha T Augustin
Madona, Thiruppady lane, Mannuthy, Thrissur – 680 651, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_85_22

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How to cite this article:
Augustin AT. Atypical presentation of multiple sclerosis – A few points to ponder. Kerala J Ophthalmol 2022;34:191

How to cite this URL:
Augustin AT. Atypical presentation of multiple sclerosis – A few points to ponder. Kerala J Ophthalmol [serial online] 2022 [cited 2023 Feb 5];34:191. Available from: http://www.kjophthal.com/text.asp?2022/34/2/191/355053

The article by Dr. Aishwarya Angadi has brilliantly highlighted how multiple sclerosis can present as unilateral internuclear ophthalmoplegia. The author has meticulously examined the patient and presented it along with the detailed neurological findings. Early detection of multiple sclerosis can go a long way in reducing the morbidity of the disease through timely treatment and intervention.

From an academic point of view, there are a few points that I would like to contribute.

  1. Since the patient complained of visual blurring, subclinical optic neuritis should have been ruled out with a visually evoked potential test.[1]
  2. In the cerebrospinal fluid study, the number of oligoclonal bands is significant for the prognosis of multiple sclerosis.[2]
  3. In a case of multiple sclerosis, NeuroMyelitis Optica Immunoglobulin G (NMOIgG) and anti-Myelin Oligodendrocyte Glycoprotein (anti-MOG) antibody should be tested.[3],[4],[5]
  4. Lesions on Magnetic Resonance Imaging (MRI) should fulfil McDonald's criteria to qualify as those of multiple sclerosis.
  5. MRI orbit is relevant in this case. Also, MRI brainstem should show lesions in the medial longitudinal fasciculus to explain the internuclear ophthalmoplegia.
  6. As this patient was positive for Anti Neutrophil Cytoplasmic Antibodies (ANCA), autoimmune vasculitis should also be ruled out.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Zafeiropoulos P, Katsanos A, Kitsos G, Stefaniotou M, Asproudis I. The contribution of multifocal visual evoked potentials in patients with optic neuritis and multiple sclerosis: A review. Doc Ophthalmol 2020;142:283-92.  Back to cited text no. 1
Dalla Costa G, Passerini G, Messina M, Moiola L, Rodegher M, Colombo B, et al. Clinical significance of the number of oligoclonal bands in patients with clinically isolated syndromes. J Neuroimmunol 2015;289:62-7.  Back to cited text no. 2
Dave D, Khan F, Rohatgi S, Nirhale S, Rao P, Naphade P. Atypical Multiple Sclerosis with Antibody to MOG. Neurol India 2020;68:1235-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
Dolbec K, Chalkley J, Sudhakar P. Atypical MOG antibody disease presenting with typical multiple sclerosis lesions. Mult Scler Relat Disord 2020;44:102342.  Back to cited text no. 4
Lana-Peixoto MA, Talim N. Neuromyelitis Optica Spectrum Disorder and Anti-MOG Syndromes. Biomedicines 2019;7:42.  Back to cited text no. 5


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