Author:

Abstract

Aim: To describe a case of multiple sclerosis which presented with sudden-onset esotropia.

Method: A case is documented with history, ophthal­mic and neurological findings and management. Multiple sclerosis is discussed in relation to paedia­tric onset.

Results: A previously healthy boy aged 2 years 10 months presented with malaise, fever and sudden-onset right esotropia, which followed a urinary tract infection 4 weeks earlier. Ophthalmic examination revealed bilateral papilloedema. Magnetic resonance imaging (MRI) showed multiple areas or high signal in the basal ganglia and subcortical white matter in the occipital and right frontal lobes. Steroid medica­tion was commenced and resulted in a reduction in signs and symptoms. The provisional diagnosis was acute demyelinating encephalomyelitis (ADKM). Following two further similar episodes a diagnosis of multiple sclerosis was made based on the variation or neurological signs and resolving demyelination on MRI brain scans.

Keywords: Acute demyelinating encephalomyelitis, Esotropia, Multiple sclerosis, Optic atrophy, Papilloedema