Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case report
Aim: To report a case of sudden-onset diplopia, blurred vision and an inability of the left eye to fully abduct following trauma. Subsequent examinations showed significant variability leading to a possible diagnosis of myasthenia gravis. Methods: This is a case report of a 7-year-old boy with a 2...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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White Rose University Press
2012-08-01
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| Series: | British and Irish Orthoptic Journal |
| Subjects: | |
| Online Access: | https://www.bioj-online.com/articles/61 |
| _version_ | 1818969995966676992 |
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| author | Danielle E. Eckersley Lorraine North J. Govan |
| author_facet | Danielle E. Eckersley Lorraine North J. Govan |
| author_sort | Danielle E. Eckersley |
| collection | DOAJ |
| description | Aim: To report a case of sudden-onset diplopia, blurred vision and an inability of the left eye to fully abduct following trauma. Subsequent examinations showed significant variability leading to a possible diagnosis of myasthenia gravis. Methods: This is a case report of a 7-year-old boy with a 2-day history of blurred vision, horizontal diplopia and headaches following a bump to the left side of his head that presented as a left sixth nerve paresis. The history, orthoptic findings, investigations and possible aetiologies are discussed. Results: Orthoptic assessments initially revealed a marked left esotropia with restriction on left abduction. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were both normal, as was monitoring of the patient’s intracranial pressures. Further orthoptic assessments demonstrated normal ocular movements on some visits whilst on other visits a restriction of left abduction was still shown. The patient then developed a vertical element with ptosis with significant variability at each visit, leading to a possible diagnosis of ocular myasthenia gravis. He was started on pyridostigmine and improvement was observed. However, low-affinity acetylcholine receptor antibodies, MuSK antibodies, Tensilon test and nerve fibre stimulation were negative and pyridostigmine was stopped. Conclusion: A question mark still hangs over the aetiology of this case. After a year of monitoring it was decided that the most suitable management for this patient was botulinum toxin. Following one injection the patient is currently straight and demonstrating stereopsis |
| first_indexed | 2024-12-20T14:29:27Z |
| format | Article |
| id | doaj.art-291c8c7926a84ac990a011b33d18d3e6 |
| institution | Directory Open Access Journal |
| issn | 2516-3590 |
| language | English |
| last_indexed | 2024-12-20T14:29:27Z |
| publishDate | 2012-08-01 |
| publisher | White Rose University Press |
| record_format | Article |
| series | British and Irish Orthoptic Journal |
| spelling | doaj.art-291c8c7926a84ac990a011b33d18d3e62022-12-21T19:37:39ZengWhite Rose University PressBritish and Irish Orthoptic Journal2516-35902012-08-019747710.22599/bioj.6160Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case reportDanielle E. Eckersley0Lorraine North1J. Govan2Frimley Park Hospital NHS Trust, Frimley, SurreyFrimley Park Hospital NHS Trust, Frimley, SurreyFrimley Park Hospital NHS Trust, Frimley, SurreyAim: To report a case of sudden-onset diplopia, blurred vision and an inability of the left eye to fully abduct following trauma. Subsequent examinations showed significant variability leading to a possible diagnosis of myasthenia gravis. Methods: This is a case report of a 7-year-old boy with a 2-day history of blurred vision, horizontal diplopia and headaches following a bump to the left side of his head that presented as a left sixth nerve paresis. The history, orthoptic findings, investigations and possible aetiologies are discussed. Results: Orthoptic assessments initially revealed a marked left esotropia with restriction on left abduction. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were both normal, as was monitoring of the patient’s intracranial pressures. Further orthoptic assessments demonstrated normal ocular movements on some visits whilst on other visits a restriction of left abduction was still shown. The patient then developed a vertical element with ptosis with significant variability at each visit, leading to a possible diagnosis of ocular myasthenia gravis. He was started on pyridostigmine and improvement was observed. However, low-affinity acetylcholine receptor antibodies, MuSK antibodies, Tensilon test and nerve fibre stimulation were negative and pyridostigmine was stopped. Conclusion: A question mark still hangs over the aetiology of this case. After a year of monitoring it was decided that the most suitable management for this patient was botulinum toxin. Following one injection the patient is currently straight and demonstrating stereopsishttps://www.bioj-online.com/articles/61Botulinum toxinChildhood myasthenia gravisConcomitant strabismusEsotropiaIncomitant strabismusSeronegative myasthenia gravisSixth nerve palsySudden-onset strabismus |
| spellingShingle | Danielle E. Eckersley Lorraine North J. Govan Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case report British and Irish Orthoptic Journal Botulinum toxin Childhood myasthenia gravis Concomitant strabismus Esotropia Incomitant strabismus Seronegative myasthenia gravis Sixth nerve palsy Sudden-onset strabismus |
| title | Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case report |
| title_full | Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case report |
| title_fullStr | Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case report |
| title_full_unstemmed | Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case report |
| title_short | Myasthenia gravis masquerading as acute sixth nerve paresis following head trauma – or vice versa? A case report |
| title_sort | myasthenia gravis masquerading as acute sixth nerve paresis following head trauma or vice versa a case report |
| topic | Botulinum toxin Childhood myasthenia gravis Concomitant strabismus Esotropia Incomitant strabismus Seronegative myasthenia gravis Sixth nerve palsy Sudden-onset strabismus |
| url | https://www.bioj-online.com/articles/61 |
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