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Case Reports
. 2017 Jan-Mar;8(1):129-132.
doi: 10.4103/0976-3147.193526.

Bilateral ptosis without upward gaze palsy: Unusual presentation of midbrain tuberculoma

Shatanik Sarkar  1 , Chaitali Patra  2 , Malay Kumar Dasgupta  1
Affiliations
Case Reports

Bilateral ptosis without upward gaze palsy: Unusual presentation of midbrain tuberculoma

Shatanik Sarkar et al. J Neurosci Rural Pract. 2017 Jan-Mar.

Abstract

Central nervous system tuberculoma can have variable presentations depending on the site and number of tuberculomas. We are reporting a rare case of an 11-year-old male child presenting with ptosis and ataxia. Clinical examination revealed bilateral partial 3rd cranial nerve palsy (ptosis without any upward gaze palsy) associated with dysdiadochokinesia and ataxia on the right side. Magnetic resonance imaging of the brain revealed a single ring-enhancing lesion in the dorsal midbrain with perifocal edema. Magnetic resonance spectroscopy provided the etiological information as tuberculoma.

Keywords: Ataxia; magnetic resonance spectroscopy; midbrain; ptosis; tuberculoma.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
An 11-year-old male child with bilateral symmetrical ptosis
Figure 2
Figure 2
Magnetic resonance imaging of brain (T1-weighted image; contrast-enhanced) showing single ring-enhancing lesion (yellow arrow) in the dorsal part of the midbrain with significant perifocal edema in adjacent part of brainstem, right cerebellar peduncle, adjacent thalamocortical tract, and periventricular region
Figure 3
Figure 3
Magnetic resonance spectroscopy showing increased lipid peak, decreased N-acetylaspartate peak with increased Ch/Cr ratio, suggestive of tuberculoma
See this image and copyright information in PMC

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