Her palpebral fissure measured 4mmm before ice was applied, and 8mm 2 minutes after the application of ice. A readily accessible test in the clinic is an ice pack test or rest test, which should result in an improvement in the ptosis, as was seen in this patient. Upon examination, the main ophthalmological finding was a unilateral ptosis. Her chief complaint was an inability to open her left eyelid, which worsened at the end of the day.
This patient presented to the emergency eye clinic with a new-onset of left lid ptosis, and an otherwise normal neurological exam. Horner’s syndrome, or oculosympathetic paresis, usually presents as mild unilateral ptosis and a miotic pupil that dilates poorly in response to dim illumination. Neuroimaging is usually required, especially if there is pupil involvement, to rule out a compressive aneurysm. Typical clinical findings are unilateral ptosis, with deficits in adduction, supraduction and infraduction. Oculomotor or CN3 dysfunction can occur due to a pathology of the brainstem nucleus or an injury of the nerve anywhere along its course. Other differential diagnosis to consider are oculomotor nerve dysfunction or Horner’s syndrome. Initial therapy for ocular myasthenia gravis typically consists of acetylcholinesterase inhibitors, such as pyridostigmine 60 mg three times daily. In patients presenting with ptosis, external ophthalmoplegia or nonphysiologic anisocoria, an alternative diagnosis should be considered. Antibodies in myasthenia gravis affect only striated muscles, therefore not being involved the pupillary dilator or sphincter muscles. Diplopia is also a common complaint, due to weakness of the extraocular muscles. Patients typically present with bilateral ptosis, which often varies throughout the course of the day. Ocular myasthenia gravis is an autoimmune disorder characterized by the presence of antibodies to postsynaptic nicotinic acetylcholine receptors (AChR) at the neuromuscular junction of striated muscle. The patient was referred to our local thoracic surgeon, and started on oral pyridostigmine with gradual improvement of the ptosis. A presumed diagnosis of ocular myasthenia gravis was made. Thoracic CT scan was performed, which showed an anterior and inferior mediastinal solid mass ( Figure 2), compatible with Type A thymoma. No obvious or gross mediastinal lymph nodes.Īcetyl choline receptor antibodies (AchR-Ab) level was >20 nmol/L (reference Range: <0.02 nmol/L). Anterior and inferior prevascular mediastinal solid mass compatible with Type A thymoma.
0 kommentar(er)
