A 31-year-old woman presenting with vertical diplopia and history of paresthesia in her hands the previous year was found to have a trochlear nerve palsy. Computed tomography showed no acute intracranial pathology. Magnetic resonance imaging revealed several white matter lesions with a demyelinating pattern. She was diagnosed with relapsing-remitting multiple sclerosis (MS) and started on immunotherapy, with no further exacerbation of MS.