Myasthenic Psuedo-Internuclear Ophthalmoplegia

Abstract

Ocular myasthenia gravis resembling the specific brain-stem sign of internuclear ophthalmoplegia has not been described in the literature with the exception of the unique case of Walsh.¹This interesting motility disturbance has recently been observed in three patients. In each case the peripheral neuromuscular disorder closely mimicked a syndrome pathognomonic of a focal lesion involving the medial longitudinal fasciculus. The purpose of this report is to present the unusual ocular motility found in these three cases and to emphasize the importance of an antimyasthenic agent in this differential diagnosis. <h3>Report of Cases</h3><h3>Case 1.</h3> —A 25-year-old Negro woman was seen with asthenopic symptoms of two months' duration. No history of ptosis, diplopia, or fatigability could be elicited. On examination a mild right ptosis was noted. The pupils were normal as were other parameters of ocular function, with the exception of extraocular movements which were of great interest. The patient