A 46-year-old man presented with horizontal diplopia over 5 days. He had psoriatic arthritis that had been stable on etanercept for several years but he had interrupted treatment for 3 months for fear of immunosuppression during the coronavirus pandemic. He had restarted therapy 3 months before presentation after worsening arthritis. On examination, he had bilateral exotropia with impaired adduction and gaze-evoked abducting nystagmus bilaterally, as well as impaired upgaze with vertical gaze-evoked nystagmus (video 1). Pupillary responses, convergence and facial strength were spared. The remaining neurological examination was unremarkable. MR scan of the brain showed demyelination in the dorsal pons involving both medial longitudinal fasciculi (figure 1). He was treated with intravenous methylprednisolone 1 g/day for 3 days with rapid resolution of his eye movement abnormalities. Etanercept was stopped and his eye movements remained normal on follow-up 1 month later with no strabismus. Unfortunately, his psoriatic arthritis worsened, and methotrexate was started, although it was not as …

中文翻译：

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与依那西普相关的斜视双侧核间性眼肌麻痹

一名 46 岁男性出现水平复视超过 5 天。他患有银屑病关节炎，使用依那西普数年来稳定，但由于担心在冠状病毒大流行期间免疫抑制，他中断了治疗 3 个月。在关节炎恶化后，他在就诊前 3 个月重新开始了治疗。检查时，他有双侧外斜视，双侧内收和凝视诱发的外展性眼球震颤受损，以及垂直凝视诱发的眼球震颤向上凝视受损（视频 1）。瞳孔反应、收敛性和面部力量没有受到影响。其余神经系统检查无异常。脑部 MR 扫描显示背侧脑桥脱髓鞘，涉及两个内侧纵束（图 1）。他接受了静脉注射甲基强的松龙 1 克/天，连续 3 天，他的眼球运动异常迅速消退。停用依那西普，1 个月后随访时他的眼球运动保持正常，没有斜视。不幸的是，他的银屑病关节炎恶化了，开始使用甲氨蝶呤，虽然它不是...