1.A Case of Ocular Myasthenia Gravis Presenting as Double Depressor Palsy.
Kwanbok LEE ; Ungsoo Samuel KIM
Korean Journal of Ophthalmology 2014;28(2):194-196
A 65-year-old man who had been experiencing diplopia in front and down gaze for 15 days visited our hospital. Hypertropia was noted in the patient's left eye, and limitation of depression was found in the adduction, primary gaze, and abduction. Brain magnetic resonance imaging showed no remarkable findings. Two weeks after the first visit, the patient complained of ptosis in the left eye. An ice test was performed and the ptosis was resolved after the test. Then, anti-acetylcholine receptor binding antibody levels were checked and found to be slightly elevated. We prescribed methylprednisolone per os 24 mg for 2 weeks, and his symptoms improved after the 2-week treatment. Five weeks after his first visit, the patient showed an ortho result in the alternate prism cover test and normal ocular movements. This may be the first case in which ocular myasthenia gravis presented as double depressor palsy, and in such cases, the possibility of ocular myasthenia gravis should be considered to rule out double depressor palsy.
Aged
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Diagnosis, Differential
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Diplopia/*diagnosis/*etiology
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Humans
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Male
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Myasthenia Gravis/*complications/*diagnosis
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Ocular Motility Disorders/diagnosis/etiology
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Strabismus/diagnosis/etiology
3.A Catastrophic-Onset Longitudinal Myelitis Accompanied by Bilateral Internuclear Ophthalmoplegia in a Patient with Systemic Lupus Erythematosus.
Chang Woo RHEU ; Sang Il LEE ; Wan Hee YOO
Journal of Korean Medical Science 2005;20(6):1085-1088
Transverse myelitis (TM) extending from midbrain to the entire spinal cord accompanied by internuclear ophthalmoplegia is extremely rare but cause serious central nervous system complications in patients with systemic lupus erythematosus. We report a case of a 28-yr-old woman with TM extending from the midbrain to the conus medullaris longitudinally and internuclear ophthalmoplegia associated with systemic lupus erythematosus. Her neurological symptoms had an abrupt catastrophic onset and rapidly progressed to respiratory failure within 24 hr. Bilateral internuclear ophthalmoplegia was also followed by TM. Brain MR images showed definite brainstem lesions, which were deeply associated with internuclear ophthalmoplegia, and diffuse signal changes in the whole spinal cord, medulla, pons and midbrain. Clinical improvement of her ophthalmoplegia and of neurological dysfunction of the upper extremities was noted after prompt and aggressive treatment with intravenous pulsed methylprednisolone and cyclophosphamide. However, the neurological dysfunction of the lower limbs and bladder and colon paralysis were almost unchanged until six months passed.
Adult
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Cyclophosphamide/therapeutic use
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Female
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Humans
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Lupus Erythematosus, Systemic/*complications
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Magnetic Resonance Imaging
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Myelitis, Transverse/diagnosis/drug therapy/*etiology
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Ocular Motility Disorders/diagnosis/drug therapy/*etiology
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Prednisolone/therapeutic use