Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child
Nada Al-Yousuf,1 Lolwah Aljutaili,2 Aisha AlHuwais,2 Abdullah Almutairi,2 Hasan Alsetri,3 Moiz Bakhiet4 1Department of Ophthalmology, King Abdullah Medical City, Manama, Kingdom of Bahrain; 2College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain; 3Department...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-08-01
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| Series: | International Medical Case Reports Journal |
| Subjects: | |
| Online Access: | https://www.dovepress.com/multiple-sclerosis-presenting-with-sixth-nerve-palsy-in-a-child-peer-reviewed-fulltext-article-IMCRJ |
| _version_ | 1818437950455676928 |
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| author | Al-Yousuf N Aljutaili L AlHuwais A Almutairi A Alsetri H Bakhiet M |
| author_facet | Al-Yousuf N Aljutaili L AlHuwais A Almutairi A Alsetri H Bakhiet M |
| author_sort | Al-Yousuf N |
| collection | DOAJ |
| description | Nada Al-Yousuf,1 Lolwah Aljutaili,2 Aisha AlHuwais,2 Abdullah Almutairi,2 Hasan Alsetri,3 Moiz Bakhiet4 1Department of Ophthalmology, King Abdullah Medical City, Manama, Kingdom of Bahrain; 2College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain; 3Department of Chemistry & Biochemistry, University of California Los Angeles, Los Angeles, CA, USA; 4Department of Molecular Medicine, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of BahrainCorrespondence: Nada Al-YousufDepartment of Ophthalmology, King Abdullah Medical City, 61, King Abdulaziz Avenue, Manama, BahrainTel +973 77310071Fax +973 77310001Email nyousuf10@gmail.comAbstract: We report a child with multiple sclerosis who presented with sixth nerve palsy. She is a twelve-year-old Bahraini female presented to the ophthalmology department complaining of double vision. She also had imbalance and paraesthesia. Extraocular muscle examination showed restriction of abduction in the right eye. There was no change in vision. MRI showed right eye optic neuritis (ON) and demyelination which was indicative of multiple sclerosis (MS). Ocular coherence tomography (OCT) showed thinning of nerve fibres of both eyes which was consistent with subclinical optic neuritis. Neurological examination showed brisk knee jerk on the left side and incoordination of movement on the same side. Disability Status Scale (EDSS) showed a score of 3.0. She was given Solu-medrol 500 mg intravenously (IV) in addition to omeprazole 40 mg IV and Vitamin D3 (cholecalciferol) 50,000 IU cap weekly for 8 weeks and Neurorubine forte tablets (vitamin B1, 6, 12) once a day for 2 months. She became asymptomatic in her follow-up visits. Children with MS can present as sixth cranial nerve palsy. Clinicians should have a high index of suspicion for early diagnosis and treatment. In addition to MRI, OCT is a useful diagnostic tool for optic neuritis and MS especially in children.Keywords: demyelination, ocular coherence tomography, lateral rectus palsy, diplopia |
| first_indexed | 2024-12-14T17:32:49Z |
| format | Article |
| id | doaj.art-8aeae552183f4784a67eef5897ce45f6 |
| institution | Directory Open Access Journal |
| issn | 1179-142X |
| language | English |
| last_indexed | 2024-12-14T17:32:49Z |
| publishDate | 2021-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Medical Case Reports Journal |
| spelling | doaj.art-8aeae552183f4784a67eef5897ce45f62022-12-21T22:53:04ZengDove Medical PressInternational Medical Case Reports Journal1179-142X2021-08-01Volume 1454555067830Multiple Sclerosis Presenting with Sixth Nerve Palsy in a ChildAl-Yousuf NAljutaili LAlHuwais AAlmutairi AAlsetri HBakhiet MNada Al-Yousuf,1 Lolwah Aljutaili,2 Aisha AlHuwais,2 Abdullah Almutairi,2 Hasan Alsetri,3 Moiz Bakhiet4 1Department of Ophthalmology, King Abdullah Medical City, Manama, Kingdom of Bahrain; 2College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain; 3Department of Chemistry & Biochemistry, University of California Los Angeles, Los Angeles, CA, USA; 4Department of Molecular Medicine, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of BahrainCorrespondence: Nada Al-YousufDepartment of Ophthalmology, King Abdullah Medical City, 61, King Abdulaziz Avenue, Manama, BahrainTel +973 77310071Fax +973 77310001Email nyousuf10@gmail.comAbstract: We report a child with multiple sclerosis who presented with sixth nerve palsy. She is a twelve-year-old Bahraini female presented to the ophthalmology department complaining of double vision. She also had imbalance and paraesthesia. Extraocular muscle examination showed restriction of abduction in the right eye. There was no change in vision. MRI showed right eye optic neuritis (ON) and demyelination which was indicative of multiple sclerosis (MS). Ocular coherence tomography (OCT) showed thinning of nerve fibres of both eyes which was consistent with subclinical optic neuritis. Neurological examination showed brisk knee jerk on the left side and incoordination of movement on the same side. Disability Status Scale (EDSS) showed a score of 3.0. She was given Solu-medrol 500 mg intravenously (IV) in addition to omeprazole 40 mg IV and Vitamin D3 (cholecalciferol) 50,000 IU cap weekly for 8 weeks and Neurorubine forte tablets (vitamin B1, 6, 12) once a day for 2 months. She became asymptomatic in her follow-up visits. Children with MS can present as sixth cranial nerve palsy. Clinicians should have a high index of suspicion for early diagnosis and treatment. In addition to MRI, OCT is a useful diagnostic tool for optic neuritis and MS especially in children.Keywords: demyelination, ocular coherence tomography, lateral rectus palsy, diplopiahttps://www.dovepress.com/multiple-sclerosis-presenting-with-sixth-nerve-palsy-in-a-child-peer-reviewed-fulltext-article-IMCRJdemyelinationocular coherence tomographylateral rectus palsydiplopia |
| spellingShingle | Al-Yousuf N Aljutaili L AlHuwais A Almutairi A Alsetri H Bakhiet M Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child International Medical Case Reports Journal demyelination ocular coherence tomography lateral rectus palsy diplopia |
| title | Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child |
| title_full | Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child |
| title_fullStr | Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child |
| title_full_unstemmed | Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child |
| title_short | Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child |
| title_sort | multiple sclerosis presenting with sixth nerve palsy in a child |
| topic | demyelination ocular coherence tomography lateral rectus palsy diplopia |
| url | https://www.dovepress.com/multiple-sclerosis-presenting-with-sixth-nerve-palsy-in-a-child-peer-reviewed-fulltext-article-IMCRJ |
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