Intermittent Anisocoria as Presenting Sign of Relapsing-Remitting Multiple Sclerosis

Abstract

A 36-year-old male presented for an examination reporting intermittent anisocoria of one week duration. Over a period of one-month, ocular findings consisted of intermittent and variable anisocoria, diplopia, and torsional nystagmus. A diagnosis of relapsing-remitting multiple sclerosis (MS) was made using the McDonald criteria based on brainstem syndrome, optic neuropathy, transverse myelitis symptoms, multifocal areas of demyelination in the spinal cord on MRI, and the absence of MS mimickers in lab work. In this case report, eye care providers are alerted to the possibility of intermittent anisocoria as a presenting sign of relapsing-remitting multiple sclerosis.