DR. A. BALRAJ

DR. ADITYA ANAND

Abstract

A 48 year old male presented with drooping of right eyelid X 3 months & left eyelid X 1 month. Associated with history of binocular diplopia and restricted extra-ocular movements. History of 5 kg weight loss in the last 2 months. Best‑corrected visual acuity in both eyes was 6/18. Both eyes showed severe ptosis with restriction of extra-ocular movements in all gazes except abduction in both the eyes. MRI brain suggestive of multiple ring enhancing lesion in Left frontal lobe, Right cerebellum and Brainstem predominantly in midbrain suggestive of tubercular granuloma. Chest Xray showed active infiltrate in left lung. He was started on low‑dose steroids along with antitubercular therapy. There was no improvement after continuing ATT for 1½ years. To the best of our knowledge, this is the first case to be reported with bilateral third and fourth nerve palsy in a case of brain‑stem tuberculoma. Delay in diagnosis and treatment result in poor prognoses and severe neurological sequelae.