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Internuclear ophthalmoplegia — SCE Neurology MCQ

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ModerateMSInternuclear ophthalmoplegiaSCE Neurology

A 36-year-old man presented with horizontal diplopia worse on left gaze in a patient with previous optic neuritis. On examination, left eye failed to adduct and right eye abducted with nystagmus. Initial investigations showed: convergence was preserved and MRI showed a dorsal pontine lesion. What is the most likely diagnosis?

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Correct answer: A — Internuclear ophthalmoplegia

The best answer is “Internuclear ophthalmoplegia”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Neuromyelitis optica spectrum disorder”, “Balo concentric sclerosis”, “MS spasticity”, “Uhthoff phenomenon” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/