Affiliations: Deshbandhu Park, Sonarpur, Kolkata, West Bengal,
India | Merlin Sapphire, Kolkata, West Bengal, India | 111, Narkeldanga Main Road, Kolkata, West Bengal,
India | A1/8 Bidhan Abasan, Salt Lake City, Kolkata, West
Bengal, India
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.