Bielschowsky-lutz-cogan syndrome (internuclear ophthalmoplegia)   144

General: Lesion in the medial longitudinal fasciculus; anterior internuclear ophthalmoplegia consists of paresis of convergence with paresis of homolateral medial rectus muscle during lateral gaze toward opposite side of the lesion; in posterior internuclear ophthalmoplegia, convergence is not affected, while the homolateral medial rectus muscle is paralytic on lateral gaze; the most common causes in young patients include a demyelinating process such as multiple sclerosis, whereas an ischemic process is more common in the elderly; other reported causes of brainstem infarction associated with internuclear ophthalmoplegia include sickle cell trait, periarteritis nodosa, Wernicke encephalopathy, 'crack' cocaine smoking.

Ocular: Unilateral or bilateral palsy of the medial rectus muscle during conjugate lateral gaze but with or without normal function of this muscle during convergence, depending on the type of internuclear ophthalmoplegia; dissociated nystagmus in the maximal abducted contralateral eye.

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Rich JR, et al. Bilateral internuclear ophthalmoplegia after trauma. Arch Ophthalmol 1974; 92:69.