In patients with multiple ovoid-shaped demyelinating lesions on MRI, what additional finding might be present during a physical exam?

Adduction weakness upon lateral gaze is a common finding in patients with demyelinating conditions, particularly multiple sclerosis (MS). This symptom can be attributed to a dysfunction of the medial longitudinal fasciculus (MLF), which is a neural pathway that coordinates eye movements. In patients with MS, demyelination can affect the MLF, leading to internuclear ophthalmoplegia. This condition manifests as an inability to adduct one eye while the other eye is adducting normally during lateral gaze, resulting in weakness of adduction on the side of the affected eye.

In the context of multiple ovoid-shaped demyelinating lesions observed on MRI, which are characteristic of MS, this finding further supports the diagnosis. Each lesion can potentially impact motor pathways, including those involved in eye movement coordination, thus presenting with specific ocular signs during a physical examination.

The other options do not reflect typical clinical findings associated with demyelinating lesions in the context of MS. For instance, complete absence of reflexes suggests a lower motor neuron pathology rather than a demyelinating one. Loss of coordination in the upper extremities is possible but would be more generalized and not specific to the ovoid lesions observed on MRI. Unilateral hearing loss is more commonly associated with other path