title: Bilateral pseudo-internuclear ophthalmoplegia in myasthenia gravis.
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.
authors.affiliation: Department of Otolaryngology, University of Tokyo, Bunkyo-ku, Japan. itoken-tky@umin.u-tokyo.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Ito
authors.forename: J
authors.initials: J
authors.lastname: Mizutani
authors.forename: T
authors.initials: T
authors.lastname: Murofushi
authors.forename: M
authors.initials: M
authors.lastname: Mizuno
mesh_terms: D000328:Adult; D004172:Diplopia / Q000209:etiology; D004584:Electronystagmography; D005133:Eye Movements; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000150:complications* / Q000601:surgery; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013934:Thymectomy; D014012:Tinnitus / Q000209:etiology