A Case of Ocular Myasthenia Gravis Presenting as Double Depressor Palsy
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A 65-year-old man who had been experiencing diplopia in front and down gaze for 15 days visited ourhospital. Hypertropia was noted in the patient’s left eye, and limitation of depression was found in theadduction, primary gaze, and abduction. Brain magnetic resonance imaging showed no remarkablefindings. Two weeks after the first visit, the patient complained of ptosis in the left eye. An ice test wasperformed and the ptosis was resolved after the test. Then, anti-acetylcholine receptor binding antibodylevels were checked and found to be slightly elevated. We prescribed methylprednisolone per os 24 mg for2 weeks, and his symptoms improved after the 2-week treatment. Five weeks after his first visit, the patientshowed an ortho result in the alternate prism cover test and normal ocular movements. This may be thefirst case in which ocular myasthenia gravis presented as double depressor palsy, and in such cases, thepossibility of ocular myasthenia gravis should be considered to rule out double depressor palsy.
Abstract
A 65-year-old man who had been experiencing diplopia in front and down gaze for 15 days visited ourhospital. Hypertropia was noted in the patient’s left eye, and limitation of depression was found in theadduction, primary gaze, and abduction. Brain magnetic resonance imaging showed no remarkablefindings. Two weeks after the first visit, the patient complained of ptosis in the left eye. An ice test wasperformed and the ptosis was resolved after the test. Then, anti-acetylcholine receptor binding antibodylevels were checked and found to be slightly elevated. We prescribed methylprednisolone per os 24 mg for2 weeks, and his symptoms improved after the 2-week treatment. Five weeks after his first visit, the patientshowed an ortho result in the alternate prism cover test and normal ocular movements. This may be thefirst case in which ocular myasthenia gravis presented as double depressor palsy, and in such cases, thepossibility of ocular myasthenia gravis should be considered to rule out double depressor palsy.
참고문헌 (4)
- Nayak BK, "Acquired double depressor palsy", Indian J Ophthalmol, 31, pp.77~78 (1983)
- Vaphiades MS, "Ocular myasthenia gravis", Curr Opin Ophthalmol, 23, pp.537~542 (2012)
- Jacobs L, "The lesions producing paralysis of downward but not upward gaze", Arch Neurol, 28, pp.319~323 (1973)
- Golnik KC, "An ice test for the diagnosis of myasthenia gravis", Ophthalmology, 106, pp.1282~1286 (1999)