The occurrence of any form of internal ophthalmoplegia always arouses the clinical interest and frequently presents itself as a diagnostic challenge to the examiner. It is well known that disturbances of ocular function, especially pupillary, are commonly encountered in patients with syphilitic involvement of the central nervous system. However, the presence of total internal ophthalmoplegia of one eye as the only clinical sign of syphilis of the central nervous system is extremely rare.
A review of the medical literature of the past decade (Quarterly Cumulative Index Medicus, 1935-1945) reveals no report in English describing such an occurrence. In 1935 Puglisi-Duranti,1 a Spanish ophthalmologist, reported a total of 3 cases of internal ophthalmoplegia as an isolated clinical phenomenon. In 1937 he reported 1 additional case.2 In 2 of these 4 cases the author described syphilis as the underlying cause of the ocular disturbance. The first case was that of
ZELIGS MA, JOSEPH GF. UNILATERAL INTERNAL OPHTHALMOPLEGIA: SOLE CLINICAL SIGN IN PATIENT WITH SYPHILITIC MENINGITIS. Arch NeurPsych. 1945;54(5):389–390. doi:10.1001/archneurpsyc.1945.02300110073012
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