Diplopia due to cranial neuropathy may be the initial sign of syphilis affecting the central nervous system. We report a case of seronegative syphilis in a patient who presented with an isolated abducens palsy. Magnetic resonance imaging revealed an intrapontine lesion, and diagnosis was made with lumbar puncture, which showed a meningoencephalitic process, an unusual manifestation of tertiary syphilis.
Report of a Case.
—A 34-year-old healthy man developed horizontal diplopia without associated headache or other neurologic symptoms. He noted mild, generalized myalgia, which spontaneously abated after 1 day. The results of the neuro-ophthalmic examination were unremarkable, except for the presence of a right abduction defect. In addition, the right abduction saccade was slowed. Results of forced duction and intravenous edrophonium chloride tests were normal. The cranial nerves were otherwise unremarkable, and a medical evaluation that included chest roentgenography, serum antinuclear antibody assay, and VDRL were negative. The results of computed
Slavin ML, Haimovic I, Patel M. Sixth Nerve Palsy and Pontocerebellar Mass due to Luetic Meningoencephalitis. Arch Ophthalmol. 1992;110(3):322. doi:10.1001/archopht.1992.01080150020011