Brainstem stroke presenting as isolated bilateral ptosis

2021 ◽  
Vol 14 (7) ◽  
pp. e243220
Author(s):  
Sunil James ◽  
Karunakaran Pradeep Thozhuthumparambil
Keyword(s):  
Elderly Patient ◽  
Myasthenia Gravis ◽  
Neurological Deficit ◽  
Bilateral Ptosis ◽  
Brainstem Stroke ◽  
Clinical Phenomenon ◽  
Midbrain Infarction

Pure midbrain infarctions not involving surrounding structures are an uncommon clinical phenomenon. A midbrain infarction that results in isolated bilateral ptosis as the only neurological deficit is much rarer and an easy diagnosis to miss; therefore, potentially leading to further downstream complications. We describe the case of an elderly patient who presented with isolated bilateral ptosis, initially thought to be consequent to myasthenia gravis but subsequently identified to have a perforator infarct in the midbrain, resulting in his symptoms.

Unilateral Oculomotor Palsy and Bilateral Ptosis From Paramedian Midbrain Infarction

1991 ◽  
Vol 48 (9) ◽  
pp. 983-986 ◽  
Author(s):  
G. T. Liu ◽  
E. J. Carrazana ◽  
M. E. Charness
Keyword(s):  
Oculomotor Palsy ◽  
Bilateral Ptosis ◽  
Midbrain Infarction

Bulbar presentations of myasthenia gravis in the elderly patient

2001 ◽  
Vol 115 (1) ◽  
pp. 1-3 ◽  
Author(s):  
H. R. Sharp ◽  
A. Degrip ◽  
D. B. Mitchell ◽  
A. Heller
Keyword(s):  
Elderly Patient ◽  
Myasthenia Gravis ◽  
Clinical Features ◽  
The Elderly ◽  
Aerodigestive Tract ◽  
Myasthenic Crisis ◽  
Upper Aerodigestive Tract

We report on three cases of patients whose primary symptoms of myasthenia gravis were related to the upper aerodigestive tract. Symptoms had been present unrecognized in all patients for up to three years, and one patient subsequently developed a myasthenic crisis. We highlight the clinical features of myasthenia gravis to allow its prompt recognition in patients presenting to the ENT surgeon or physician.

scholarly journals Seeking spark- ocular myasthenia gravis in a juvenile – an Indian case report

2020 ◽  
Vol 5 (7) ◽  
pp. 190-193
Author(s):  
Dr. Usha BR. ◽  
◽  
Dr. Nandhini K ◽  
Dr. Chaitra MC ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Autoimmune Disorder ◽  
Bilateral Ptosis ◽  
Ocular Myasthenia ◽  
Ocular Myasthenia Gravis ◽  
History Of ◽  
High Index Of Suspicion

Myasthenia gravis (MG) is a rare autoimmune disorder affecting neuromuscular junction by muscleweakness. Myasthenia gravis can be generalized or localized as ocular myasthenia gravis. Casepresentation: We report an 8-year-old boy who presented with 10 days history of drooping of botheyelids and 8 days history of diplopia. Examination revealed bilateral ptosis. A diagnosis of JuvenileOcular Myasthenia gravis was made when symptoms improved with intramuscular Edrophoniumadministration. He was commenced on oral Neostigmine at a dose of 2mg/Kg/ day,4 hourly individed doses and is on regular follow up and had a good response. Conclusion: Ocular Myastheniagravis (OMG) is a rare disease in itself. A high index of suspicion is required in a juvenile as it iseven rarer.

Paramedian Midbrain Infarction Presenting as Bilateral Asymmetric Ptosis: A Case Report and Review of Literature

2019 ◽  
Vol 2 (1) ◽  
pp. 47-49
Author(s):  
Dhananjay Gupta ◽  
Pradeep R. ◽  
Anish Mehta ◽  
Mahendra Javali ◽  
Purshottam T. Acharya ◽  
...  
Keyword(s):  
Case Report ◽  
Extraocular Muscle ◽  
Extraocular Muscles ◽  
Oculomotor Nerve ◽  
Review Of Literature ◽  
Bilateral Ptosis ◽  
Anatomical Correlation ◽  
Midbrain Infarction ◽  
Oculomotor Function ◽  
Midbrain Stroke

Brainstem strokes can have protean ophthalmological manifestations including pupillary and extraocular muscle pareses. Incomplete paresis of oculomotor function is more common than complete paresis owing to the selective involvement of subnuclei or fascicles for various extraocular muscles. Here, we report a case of right paramedian midbrain stroke presented with asymmetric bilateral ptosis. We discuss the anatomical correlation of this presentation with the structure of oculomotor nerve nuclei and its fascicles.

scholarly journals Isolated trochlear palsy as the only presentation of midbrain infarction: a case report

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110082
Author(s):  
Wen-Ching Chen ◽  
Ying-Sheng Li ◽  
Poyin Huang
Keyword(s):  
Case Report ◽  
Recent Literature ◽  
Brain Magnetic Resonance Imaging ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Current Case ◽  
Brainstem Stroke ◽  
Midbrain Infarction ◽  
Magnetic Resonance Imaging Mri ◽  
Trochlear Palsy

Trochlear palsy often results from traumatic, congenital and microvascular disorders. An intra-axial lesion as a cause of trochlear palsy is uncommon. Moreover, it usually accompanies other neurological deficits. Isolated trochlear palsy as the only presentation of brainstem stroke is unexpected. This current case report describes a 74-year-old male that presented with trochlear palsy without other neurological signs. Brain magnetic resonance imaging (MRI) revealed an acute midbrain infarction. The case report also reviews recent literature and provides a stepwise algorithm for clinicians to approach patients with trochlear palsy. Despite its rarity, clinicians are advised to consider ischaemic stroke as a cause of trochlear palsy even without other neurological deficits. Early MRI should be performed for prompt and proper management.

scholarly journals Seronegative Myasthenia Gravis, as a Rare Autoimmune Condition in Turner Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Rimah Sharief ◽  
Amir Miodovnik ◽  
Roja Motaghedi
Keyword(s):  
Myasthenia Gravis ◽  
Developmental Delay ◽  
Turner Syndrome ◽  
Muscle Weakness ◽  
Unique Combination ◽  
Bilateral Ptosis ◽  
The Past ◽  
Seronegative Myasthenia Gravis ◽  
Autoimmune Conditions ◽  
Autoimmune Condition

Girls with Turner syndrome (TS), especially with isochromosome 46,X,i(X)(q10), are prone to develop autoimmunity. Associations of several autoimmune conditions with TS have been frequently described in the past. However, the unique combination of TS and myasthenia gravis (MG) has been reported only once before in a girl with mosaic monosomy 45,X/46,XX. Here, we present the second case of a girl affected with seronegative MG but with mosaic isochromosome TS. This is a child with developmental delay presented with muscle weakness, frequent fall, and bilateral ptosis. Diagnosis of MG was made based on positive Tensilon and electromyography tests and excellent response to intravenous immunoglobulin. At the age of 11 years due to short stature and developmental delay, a karyotype was done and revealed the mosaic isochromosome 45,X/46,X,i(X)(q10). Overall, clinicians should be aware of the vulnerability of girls with TS to autoimmunity, especially if the isochromosome 46,X,i(X)(q10) karyotype is identified. Furthermore, if a child with TS develops muscle weakness, ptosis, or ophthalmoplegia, MG should also be included in the differential diagnosis, particularly if other concurrent autoimmune conditions are present.

Adult Ocular Myasthenia Gravis Conversion: A Single-Center Retrospective Analysis in China

2020 ◽  
Vol 83 (2) ◽  
pp. 182-188
Author(s):  
Xuelin Feng ◽  
Xiao Huan ◽  
Chong Yan ◽  
Jie Song ◽  
Jun Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Analysis ◽  
Myasthenia Gravis ◽  
Conversion Rate ◽  
Cox Regression ◽  
Ocular Involvement ◽  
Onset Age ◽  
Bilateral Ptosis ◽  
Ocular Myasthenia ◽  
Ocular Myasthenia Gravis

Introduction: The conversion rate from ocular myasthenia gravis (OMG) to generalized myasthenia gravis (GMG) was reported to be much lower in Asian population since most OMG patients are juvenile onset. However, the exact conversion rate for adult-onset OMG to GMG is still unknown. Objective: We aimed to delineate the conversion rate and risk factors for adult patients with ocular onset to GMG. Methods: Adult myasthenia gravis (MG) patients with ocular onset (age > 18 years) were retrospectively reviewed. Patients with confined ocular involvement lasting more than 2 years (pure OMG group) and those who converted into GMG (converted OMG group) were enrolled for subsequent analysis. We then analyzed 5 clinical variables, including onset age, sex, onset symptoms, anti-acetylcholine receptor antibody (AChR Ab), and thymus CT. Survival analysis was applied to all enrolled patients to explore risk factors associated with conversion. Results: In a total number of 249 ocular-onset MG patients initially enrolled, we excluded 122 patients with OMG lasting less than 2 years. The remaining 127 patients were enrolled, including 106 converted OMG and 21 pure OMG patients. Converted OMG patients had an older onset age (threshold: 43 years) and higher anti-AChR Ab titer (threshold: 6.13 nmol/L). The estimated conversion rate was 70.64%. Moreover, 67% of conversion occurred within 2 years after onset. Cox regression of survival analysis revealed that higher anti-AChR Ab titer and bilateral ptosis were associated with a higher conversion rate. Conclusions: The conversion of adult OMG was associated with anti-AChR Ab titer, onset age, and bilateral ptosis. The estimated conversion rate of Chinese adult OMG patients was 70%.

scholarly journals A case of midbrain infarction causing ipsilateral mydriasis, contralateral superior rectus palsy, and bilateral ptosis

2012 ◽  
Vol 34 (9) ◽  
pp. 1683-1684 ◽  
Author(s):  
Tsukasa Saito ◽  
Asuka Asanome ◽  
Jun Sawada ◽  
Takayuki Katayama ◽  
Naoyuki Hasebe
Keyword(s):  
Bilateral Ptosis ◽  
Superior Rectus ◽  
Midbrain Infarction

scholarly journals Pembrolizumab-induced myasthenia gravis-like disorder, ocular myositis, and hepatitis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Chia-Yi Tian ◽  
Yang-Hao Ou ◽  
Shih-Liang Chang ◽  
Chih-Ming Lin
Keyword(s):  
Myasthenia Gravis ◽  
Urothelial Carcinoma ◽  
Low Dose ◽  
Oral Steroid ◽  
High Grade ◽  
Bilateral Ptosis ◽  
Programmed Death ◽  
Number Of Patients ◽  
Oral Steroids ◽  
Dose Oral

Abstract Introduction Pembrolizumab and other immune checkpoint inhibitors are the emerging treatment for selected, high-grade malignancies. However, a small number of patients are unable to tolerate its adverse effects, leading to discontinuation of this potentially life-changing therapy. In this study, we present a case of high-grade urothelial carcinoma patient, who experienced neurocomplications during the first pembrolizumab administration. However, we were able to limit the adverse effect by concomitant use of low-dose oral steroids. Case presentation A 75-year-old Taiwanese female with high-grade urothelial carcinoma of the left ureter came to the neurology clinic with complaints of acute onset of bilateral ptosis 16 days after her first infusion of pembrolizumab. It was found that she developed complete bilateral ptosis and limited extraocular muscle movements. Myasthenia gravis-related antibodies and repetitive stimulation test were negative. We diagnosed her with pembrolizumab-induced myasthenia gravis-like disorder and myositis based on clinical symptoms and elevation of muscle enzymes. We commenced methylprednisolone pulse therapy followed by oral steroid therapy with gradual resolution of the symptoms. Three months later, the patient received a second cycle of pembrolizumab with low-dose oral steroids without any complications. Conclusion Pembrolizumab exerts its antitumor activity by interfering with the binding of programmed death 1 and its ligand, programmed death ligand 1. As a result, enhanced cytotoxic T cells can recognize tumor cells and induce cellular death. However, neurological complications may be severe and require prompt recognition and treatment. Our case demonstrated that concomitant use of low-dose steroids and pembrolizumab might prevent such complications.

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