Abstract
A six and a half year old child presented with four months history of bilateral ptosis
which was initially diagnosed as ocular myasthenia gravis after a positive edrophonium
test and being treated accordingly. Over the course of time he developed headache
with occasional vomiting, so referred to us for evaluation. Neurological examination
revealed presence of mild bilateral ptosis with mid-dilated pupils sluggishly reacting
to light and gait ataxia. There was complete sparing of other extra ocular muscles.
Ophthalmoscopy showed bilateral papilloedema. CT scan and later on MRI of brain pointed
out multiple tuberculomas both at cortical and subcortical (including midbrain and
cerebellum) level with obstructive hydrocephalus. Conservative therapy to decrease
intracranial pressure was initiated soon along with antitubercular drugs, and response
was found to be dramatic. Isolated bilateral ptosis as the initial presenting feature
of multiple intracranial tuberculoma is very rare. Moreover tuberculoma of brain masquerading
as ocular myasthenia with false positive edrophonium test is unique and hence reportable.
Keywords
Bilateral ptosis - ocular myasthenia - false positive - multiple tuberculomas
