ICNC Abstracts, ICNC 2018

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Congenital double elevator palsy with ptosis in a child
Subramanian Velusamy, Subramanian Velusamy, Balaraman Krishnakumar, Balasubramanian Radhakrishnan, Rajendran Abinaya, Kandasamy Sivakumar, Kandasamy Sivakumar

Last modified: 2018-09-09


Introduction: Double elevator palsy  also known as monocular elevation defect is characterised by unilateral limitation of elevation of eye due to weakness of elevators-superior rectus and inferior oblique and is associated with ptosis.Congenital form is sporadic and acquired form is secondary to tumour-pineocytoma or stroke.Only a few cases have been  reported.Case Report: 10 year old girl presented with drooping of left upper eyelid since infancy.There was no diurnal variation or defective vision or diplopia.Birth and developmental history was normal and family history was negative.On examination ,visual acuity was 6/9 both eyes,PERL, Fundi were normal.In left eye- child had ptosis,and in primary position, and in adductrion and abduction, elevation was restricted .Depression, adduction and abduction were normal.Bells phenomenon was intact.There was no MarcusGunn phenomenon.Left eye was orthophoric and there was no abnormal head posture.Forced duction test was negative.Rest of neurolgic and other systems examination,MRI brain were normal.Discussion:In elevator palsy due to inferior rectus  restriction,forced duction is positive and Bells phenomenon is absent  and in supranuclear elevator muscle innervations defect as in our case, forced duction is negative and Bells phenomenon will be intact.Patient may present with ptosis.Affectd eye will be hypotropic,but  orthophoric in some.MarcusGunn phenomenon and abnormal head posture may be present in some.Surgery is needed if there is abnormal head posture or hypotopia.Conclusion:The case is reported to bring out an awareness amongst neurologists about this rare condition and one should do a detailed ophtholmolgic evaluation with the help of ophtholmolgist, so that unnecessary neurologic investigations may be avoided.


ptosis,double elevator palsy,

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