Horizontal gaze palsy following intraoral local anesthesia, a first manifestation of multiple sclerosis

Abstract

Introduction: Different type of anesthesia has been implicated in the exacerbation of multiple sclerosis. Moreover, dental anesthesia is related to ophthalmologic complications such as diplopia due to oculomotor nerves palsy. Various pathophysiologic mechanisms are discussed: intravascular (arterial/vein) injection of anesthetic, reflex vasospasm and diffusion of local anesthetic. Case report: A 36-year-old woman who presented an horizontal left gaze palsy, bilateral nystagmus in extreme gaze and left peripheral facial palsy after dental anesthesia. The patient recovered peripheral facial palsy within 3 h after the injection. As a result of the magnetic resonance, it was initiated high doses systemic corticosteroid treatment and the gaze palsy resolved within three weeks. The patient was diagnosed with peripheral facial palsy secondary to dental anesthesia and multiple sclerosis. Conclusion: The concomitance of symptoms with local anesthesia complicates the etiological diagnosis of pathology, so exhaustive and detailed exam taking into consideration all factors is necessary for a proper diagnosis and treatment.

Keywords

• Horizontal gaze palsy
• Nystagmus
• Dental anesthesia
• Multiple sclerosis
• Peripheral facial palsy