Clinical Ophthalmology Open Access Full Text Article Dovepress open access to scientific and medical research C A s e r e P O r T A case of oculomotor nerve palsy associated with antimitotic spindle apparatus Jong Jin Jung Ungsoo samuel Kim Department of Ophthalmology, Kim’s eye Hospital, Konyang University College of Medicine, seoul, Korea Correspondence: Ungsoo samuel Kim Department of Ophthalmology, Kim’s eye Hospital, Konyang University College of Medicine, Youngdeungpo 4th 156, Youngdeungpo-gu, seoul, 150-034 Korea Tel +822 2639 7777 Fax +822 2677 9214 email ungsookim@kimeye.com Abstract: In this case report, we describe a case of isolated oculomotor nerve palsy associated with antibodies to mitotic spindle apparatus (anti-MSA). A 28-year-old female patient had acute, painful vertical diplopia. She had limited depression and adduction in the right eye. There was no relative afferent pupillary defect. Brain magnetic resonance imaging showed no abnormal findings. Laboratory tests were all negative, with the exception of positive anti-MSA, She had an excellent and rapid response to treatment with corticosteroids, and completely recovered after two weeks of steroid pulse therapy. Keywords: antibodies, mitotic spindle apparatus, autoimmune disease, third nerve palsy Introduction The causes of isolated oculomotor nerve palsy have been documented in various diseases. Most cases of isolated third nerve palsy are attributable to disease states that affect the vascular system, including diabetes mellitus and hypertension.1 However, we must carefully consider other causes in young patients without vasculopathic risk factors. Multiple sclerosis, Sjogren’s syndrome, antiphospholipid syndrome, and leu- kemia involving the central nervous system are rarely reported as causes of isolated oculomotor nerve palsy,2,3 but oculomotor nerve palsy associated with antibodies to mitotic spindle apparatus (anti-MSA, an auto-antinuclear antibody) has not been reported to date. We describe a patient with isolated oculomotor nerve palsy associ- ated with anti-MSA. Case report A 28-year-old woman suddenly developed painful vertical diplopia. She had been suffering from a cold for one week. She had no significant contributory past history and no systemic diseases, such as diabetes mellitus, hypertension, or coagulopathy. A full ophthalmologic examination was performed. Her best corrected visual acu- ities were 20/25 in the right eye and 20/30 in the left eye. Alternate cover prism test revealed 10 prism diopters of hypertropia in the right eye. She had limited depression and adduction in the right eye as well (Figure 1). The forced duction test was negative. There was no relative afferent pupillary defect. We performed laboratory tests, including a complete blood cell count, erythro- cyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibod- ies, antineutrophil cytoplasm antibodies, and serologic tests for viral markers. We also performed a chest x-ray and brain magnetic resonance imaging. The laboratory submit your manuscript | www.dovepress.com Dovepress DOI: 10.2147/OPTH.S16864 Clinical Ophthalmology 2011:5 549–551 © 2011 Jung and Kim, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 549