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March 1992

Sixth Nerve Palsy and Pontocerebellar Mass due to Luetic Meningoencephalitis

Author Affiliations

New Hyde Park, NY

Arch Ophthalmol. 1992;110(3):322. doi:10.1001/archopht.1992.01080150020011

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

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