Acute bilateral hypotropia and esotropia complex as first manifestation of multiple sclerosis: a case report

Nagoya J Med Sci. 2023 Nov;85(4):822-827. doi: 10.18999/nagjms.85.4.822.


A 21-year-old Japanese woman presented with sudden eye movement disorders. An ophthalmic examination revealed bilateral hypotropia and esotropia complex. Brain magnetic resonance imaging revealed abnormal signals in the posterior and medial part of the lower pontine tegmentum (including periventricular and subcortical white matter) that were suggestive of demyelination. A cerebrospinal fluid test was positive for oligoclonal bands. She was subsequently diagnosed with multiple sclerosis and was administered intravenous methylprednisolone and oral dimethyl fumarate, with complete recovery from hypotropia and esotropia after two months. Bilateral hypotropia and esotropia are important clinical signs for the accurate diagnosis of multiple sclerosis.

Keywords: hypotropia and esotropia; internuclear opthalmoplegia; magnetic resonance imaging; multiple screlosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Brain / pathology
  • Esotropia* / complications
  • Esotropia* / etiology
  • Female
  • Humans
  • Magnetic Resonance Imaging / adverse effects
  • Multiple Sclerosis* / complications
  • Multiple Sclerosis* / diagnosis
  • Ocular Motility Disorders* / etiology
  • Ocular Motility Disorders* / pathology
  • Young Adult