Pseudo-internuclear oculomotor ophthalmoplegia secondary to Guillain-Barré polyneuronitis simulating myasthenia gravis in a air transport pilot.

A 32-year old experienced co-pilot was grounded because of handicapping and disabling doulbe vision and was off-flight from October, 1969, until January, 1972. He presented with a bilateral external ophthalmoplegia with alternate extreme divergent strabismus, and polyneuronitis. The clinical picture was confused by features resembling either a polyneuronitis of the Guillain-Barrè type, (confused by a false positive Tensilon test), myasthenia gravis, or a demyelinizing process. Because the prognosis for return to flight was so contradictory in these respective conditions, a long observative followup time was essential. The pilot recovered completely after 4 months. The long 2 year followup effectively ruled out the entity of myasthenia gravis as well as a progressive demyelinizing disease. The pilot was returned to full flight duties with no handicapping residuals. He has shown no evidence of recurrence to the date of this report (April, 1974). This case was reviewed and presented for its obvious aerospace implications.