Acute Periaqueductal Midbrain Demyelinating Syndrome Presenting with Binocular Diplopia and Oculomotor Palsy: A Case Report

Background

Inflammatory demyelinating disorders of the central nervous system may present with overlapping clinical and radiological features, particularly when the initial event is confined to the brainstem. Isolated periaqueductal midbrain involvement presenting with binocular diplopia and oculomotor palsy can create diagnostic uncertainty among neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, and multiple sclerosis, especially when disease-specific antibody testing is unavailable.