Bilateral Internuclear Ophthalmoplegia: Multiple Sclerosis rather Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD)?

Abstract

Increasing knowledge about neuro-inflammatory conditions as lead to new challenges in establishing a diagnosis. Clinical distinctive features might help. We present a 34-year-old patient with bilateral internuclear ophthalmoplegia (bINO). Investigation was compatible with demyelinating central nervous system (CNS) disease. Low-positive IgG myelin oligodendrocyte glycoprotein (MOG) antibodies were found. Rituximab was started and the patient has remained without further clinical or magnetic resonance imaging (MRI) activity. Acknowledging that bINO is a wellknown manifestation of multiple sclerosis (MS) but rarely reported among MOGAD patients its occurrence might help distinguish MS from MOGAD in an apparent overlap setting, favoring MS.