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Internuclear ophthalmoplegia following African tick bite fever
  1. Pauls Auce1,
  2. Sanjeev Rajakulendran1,
  3. Alexander Nesbitt1,
  4. Roger Chinn2,
  5. Angus Kennedy1
  1. 1Department of Neurology, Chelsea and Westminster Hospital, London, UK
  2. 2Department of Radiology, Chelsea and Westminster Hospital, London, UK
  1. Correspondence to Dr Angus Kennedy, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; anguskennedy{at}

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Case history

A 29-year-old previously healthy man presented with a diarrhoeal illness, headache and malaise while in South Africa where he had been living for 6 months. Two weeks later, he developed diplopia and incoordination.

Neurological examination revealed a left internuclear ophthalmoplegia (INO) and limb ataxia. The rest of his cranial nerve examination was normal as was tone, power, reflexes and sensation in his limbs. His general systemic examination was unremarkable; in particular, there were no skin lesions. …

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