Differential Diagnosis for Internuclear Ophthalmoplegia
Single Most Likely Diagnosis
- Multiple Sclerosis (MS): This is the most common cause of internuclear ophthalmoplegia, especially in young adults. MS can lead to demyelination in the medial longitudinal fasciculus (MLF), resulting in internuclear ophthalmoplegia.
Other Likely Diagnoses
- Stroke: A stroke affecting the MLF or the paramedian pontine reticular formation can cause internuclear ophthalmoplegia. This is more common in older adults.
- Traumatic Brain Injury: Head trauma can damage the MLF, leading to internuclear ophthalmoplegia.
- Cerebral Vasculitis: Inflammation of the blood vessels in the brain can affect the MLF and cause internuclear ophthalmoplegia.
Do Not Miss Diagnoses
- Brainstem Glioma: A tumor in the brainstem can compress or invade the MLF, leading to internuclear ophthalmoplegia. Although rare, this diagnosis is critical to identify due to its potential for severe consequences if left untreated.
- Cerebral Arteriovenous Malformation (AVM): An AVM in the brainstem can cause internuclear ophthalmoplegia by damaging the MLF. Identifying this condition is crucial due to the risk of hemorrhage.
- Neurosyphilis: This is a rare but potentially treatable cause of internuclear ophthalmoplegia. Missing this diagnosis could lead to preventable neurological deterioration.
Rare Diagnoses
- Wernicke's Encephalopathy: This condition, caused by thiamine deficiency, can lead to internuclear ophthalmoplegia among other neurological symptoms.
- Behçet's Disease: A rare form of vasculitis that can affect the central nervous system, including the MLF, causing internuclear ophthalmoplegia.
- Sjögren's Syndrome: An autoimmune disorder that can rarely cause internuclear ophthalmoplegia due to CNS involvement.
- Lymphoma: Certain types of lymphoma can infiltrate the brainstem and cause internuclear ophthalmoplegia, although this is exceedingly rare.