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  • Title: Bilateral pseudo-internuclear ophthalmoplegia in myasthenia gravis.
    Author: Ito K, Mizutani J, Murofushi T, Mizuno M.
    Journal: ORL J Otorhinolaryngol Relat Spec; 1997; 59(2):122-6. PubMed ID: 9166884.
    Abstract:
    A 38-year-old male with bilateral pseudo-internuclear ophthalmoplegia (-INO) in myasthenia that could have been misdiagnosed as INO in multiple sclerosis is reported. He experienced fluctuating symptoms including double vision, imbalance, and tinnitus. His eye movements simulated bilateral INO, with a downshoot in abduction. After thymectomy, his eye movements became normal. From our case and a review of the literature, we propose that ptosis, downshoot, and fatigability are likely to be signs of pseudo-INO in myasthenia, whereas an impaired vertical smooth pursuit is unlikely. Dissociated nystagmus and monocular overshoot might be the results of central compensation.
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