A case of multiple tuberculomas of brain presenting as ocular myasthenia gravis

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