Differential Diagnosis for Internuclear Ophthalmoplegia and Facial Pain with Light Touch
- Single most likely diagnosis:
- Multiple Sclerosis (MS): This is a common cause of internuclear ophthalmoplegia (INO), which is characterized by impaired adduction of the eye on the same side as the lesion, with nystagmus of the contralateral abducting eye. Facial pain with light touch can be associated with trigeminal neuralgia, which can also occur in MS.
- Other Likely diagnoses:
- Stroke or Brainstem Infarct: A stroke affecting the medial longitudinal fasciculus (MLF) in the brainstem can cause INO. Facial pain could be due to involvement of the trigeminal nerve or its nuclei.
- Neuromyelitis Optica (NMO): This condition can cause INO and facial pain due to inflammation and demyelination in the brainstem and spinal cord.
- Syringobulbia: A syrinx (fluid-filled cavity) in the brainstem can cause INO and facial pain due to compression or damage to the surrounding neural structures.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Brainstem Glioma: A tumor in the brainstem can cause INO and facial pain. Early diagnosis is crucial for treatment and prognosis.
- Cerebral Vasculitis: Inflammation of the blood vessels in the brain can cause a variety of symptoms, including INO and facial pain. Prompt treatment is necessary to prevent further damage.
- Wernicke's Encephalopathy: This condition, caused by thiamine deficiency, can lead to brainstem dysfunction, including INO and facial pain. It is a medical emergency requiring immediate treatment.
- Rare diagnoses:
- Lyme Disease: Neuroborreliosis, the neurological manifestation of Lyme disease, can cause INO and facial pain, although this is a rare presentation.
- Sjögren's Syndrome: This autoimmune disorder can cause inflammation in the brainstem, leading to INO and facial pain, although this is an uncommon manifestation.
- Behçet's Disease: This condition can cause inflammation in the brainstem, resulting in INO and facial pain, but it is a rare diagnosis in many parts of the world.