A 25-Year-Old Man With Painless Diplopia

Sumaira Nabi, MBBS, FCPS; Shahzad Ahmed, MBBS; Fateen Rashid, MBBS; Mazhar Badshah, MBBS, FCPS

Disclosures

August 09, 2016

For symptomatic relief of diplopia, patients may be prescribed eye patches. In patients with MS, high-dose intravenous steroids may help alleviate symptoms by accelerating the resolution of the causative plaque. If the patient has relapsing-remitting MS, disease-modifying therapy can and should be instituted. Dalfampridine is a potassium-channel blocker that is being investigated for use in such cases.[19] It is thought to improve axonal function in patients with demyelinating disease and consequently improve the ocular symptoms.

Stroke, tumors, and infections are treated accordingly. Surgical intervention may be required in cases of subdural hematoma and hydrocephalus.

The prognosis of INO varies. Recovery is slow and depends on the underlying cause. Most patients with INO due to demyelinating disease have complete resolution of symptoms, whereas INO secondary to cerebrovascular disease or tumors is less likely to resolve.[20]

The patient in this case was given intravenous methylprednisolone (1000 mg/day) for 5 days, along with proton pump inhibitors and calcium supplements. He fulfilled the McDonald criteria for a clinically definite case of relapsing-remitting MS. He was started on teriflunomide as disease-modifying therapy; this is the only choice available to neurologists in Pakistan, because interferon and glatiramer are not available. The patient will be regularly monitored in the outpatient department.

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