Abducens Nerve Palsy as a presenting symptom of Multiple Sclerosis

Multiple sclerosis (MS) is a chronic disorder characterized by demyelination of the central nervous system. It often presents in women ages 18-35 with neurological symptoms such as visual loss, paresthesia, focal weakness and ataxia. Demyelination in the brainstem can result in internuclear ophthalmoplegia causing binocular horizontal diplopia. Our report details a patient with horizontal diplopia from an isolated abducens (6th) nerve palsy as the initial symptom of MS. While rare, this demonstrates the importance of including multiple sclerosis in the differential diagnosis for an isolated abducens nerve palsy, especially in younger patients with no known vascular risk factors.