Multiple Sclerosis Presenting with Bilateral Internuclear Ophthalmoplegia in a Patient with History of Dural Arteriovenous Fistula, Neurocysticercosis and Implanted Cardiac Pacemaker

Background: : Internuclear ophthalmoplegia  results in the slowing, limitation or inability to adduct one eye associated with nystagmus in the abducting eye and is caused by a lesion in the medial longitudinal fasciculus. While history is crucial (age, acuity of onset, comorbidities), brain magnetic resonance imaging (MRI) is the diagnostic test of choice for determining the underlying cause. Increasing number of patients who present with neurological problems and benefit from the diagnostic power of MRI, have implanted cardiac pacemakers and.

Objectives: Demonstrating the possibility of obtaining MRI in selected patients with implanted cardiac pacemaker.

Methods: A 39 year-old woman who had been diagnosed with intracranial dural arteriovenous fistula and neurocysticercosis, presented with sudden onset vertigo, diplopia and bilateral internuclear ophthalmoplegia. A vascular etiology was suspected because of the acuity of onset and her prior history, but an MRI could not be initially obtained to assess this, because she had a cardiac pacemaker. After collaboration with colleagues from cardiology and radiology departments, a brain MRI revealed the correct diagnosis. 

Results: Brain MRI showed a pattern characteristic for inflammatory demyelination. 

Conclusions: Many neurologists assume having a cardiac pacemaker is an absolute contraindication to performing MRI. Here, we demonstrate that MRI can be performed in selected group of patients with cardiac pacemaker when the information obtained from the MRI would change the clinical management.