title: Internuclear ophthalmoplegia associated with anti-TNFα medication.
abstract: OBJECTIVE
  To describe the presentation of an internuclear ophthalmoplegia (INO) associated with the use of anti-tumor necrosis factor α (anti-TNFα) medication.
  
  
  METHODS
  A case report of a woman, aged 27 years, who developed facial numbness, blurred vision, and diplopia on right gaze. She had a history of Crohn's disease, which was being treated by the anti-TNFα drug, adalimumab. On examination, a left INO was found.
  
  
  METHODS
  The patient was prescribed a short course of corticosteroids and adalimumab treatment was discontinued.
  
  
  RESULTS
  Magnetic resonance imaging demonstrated typical demyelinating lesions including one responsible for the INO. Following a short course of corticosteroids and the discontinuation of the adalimumab treatment, the INO resolved, resulting in a swift improvement of ocular motility over a 2-week period.
  
  
  CONCLUSIONS
  Anti-TNFα therapies have been associated with the development of demyelinating diseases. The presentation of a brainstem syndrome in a patient on anti-TNFα therapy should lead to investigation for central nervous system demyelination and cessation of the medication.
authors: Department of Orthoptics, Royal Hallamshire Hospital , Sheffield , United Kingdom and.
authors: Jonathan
authors: J
authors: Drury
authors: Simon J
authors: SJ
authors: Hickman
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D015835:Ocular Motility Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D008775:Methylprednisolone
keywords: Adalimumab; diplopia; internuclear ophtalmoplegia; neuro-ophthalmology; orthoptists; strabismus