A Case of Multiple Sclerosis Presented with 5th, 6th and 7th Cranial Nerve Paralysis

Abstract

A 36-year-old female patient was admitted to our clinic with complaints of numbness in hands, double vision, and inability to close her left eye. Her physical examination revealed horizontal diplopia, underactivity of the left lateral rectus muscle, left peripheral facial paralysis, and trigeminal sensorial neuropathy. The magnetic resonance imaging revealed hyperintense lesions, which were compatible with multiple sclerosis (MS). Therefore, systemic steroid treatment (1000 mg/day intravenous methylprednisolone for 5 days, 1 mg/kg/day oral prednisolone, reduced slowly) was administered to the patient. Within five weeks, her symptoms were regressed, and no recurrence was observed during the follow-up period of 4 years. As this case proves, MS can present with cranial nerve palsies in addition to many other different neurological symptoms. Although 5th nerve palsy is the most common cranial nerve palsy detected in MS patients, 7th and 6th nerve involvement are rarely reported in the literature. MS should always be considered in the differential diagnosis of cranial nerve palsies especially in young patients.