Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 12333  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
   Next article
   Previous article 
   Table of Contents
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (169 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this Article
   Article Figures

 Article Access Statistics
    PDF Downloaded173    
    Comments [Add]    
    Cited by others 6    

Recommend this journal


Year : 2008  |  Volume : 56  |  Issue : 2  |  Page : 212-213

Isolated bilateral ptosis as the presentation of midbrain tuberculoma

Department of Neurological Sciences, Apollo Hospitals, Hyderabad, India

Correspondence Address:
Sudhir Kumar
Department of Neurological Sciences, Apollo Hospitals, Hyderabad
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.42011

Rights and Permissions

How to cite this article:
Kumar S, Rajshekher G, Prabhakar S. Isolated bilateral ptosis as the presentation of midbrain tuberculoma. Neurol India 2008;56:212-3

How to cite this URL:
Kumar S, Rajshekher G, Prabhakar S. Isolated bilateral ptosis as the presentation of midbrain tuberculoma. Neurol India [serial online] 2008 [cited 2022 Sep 28];56:212-3. Available from: https://www.neurologyindia.com/text.asp?2008/56/2/212/42011


Isolated nuclear involvement of the oculomotor nerve is uncommon. Typical features of a nuclear third nerve lesion include unilateral third nerve palsy, bilateral superior rectus palsy and bilateral incomplete ptosis. [1] Here, we report a patient with bilateral incomplete ptosis without any other ocular or neurological signs and discuss the clinico-imaging correlation.

A 14-year-old girl presented with headache and bilateral ptosis of two weeks duration. She had no diplopia or other neurological symptoms. On examination, she had bilateral symmetrical ptosis [Figure 1], normal elevation of both eyeballs [Figure 2] and normal pupillary size and reaction. Rest of the neurological examination was normal.

The magnetic resonance imaging (MRI) brain revealed a thick-walled ring-enhancing lesion in the dorsal midbrain in the region of the oculomotor nucleus, possibly affecting the region of the caudal central (levator palpebrae superioris) subnucleus [Figure 3]. Radiological features were suggestive of tuberculoma. She was empirically started on antituberculous treatment and steroids, with which she showed clinical improvement.

Isolated bilateral ptosis has been previously reported in association with midbrain lesions due to subacute encephalitis [2] and midbrain hemorrhage. [3] It should be noted, however, that it is more common to find ptosis in association with upgaze paresis. This is because the unpaired superior rectus subnuclei are located medially in close association with the caudal central subnucleus (levator palpebrae subnucleus). This case is reported for its unique clinical presentation, which can be explained on the basis of lesion location on MRI. To the best of our knowledge, isolated bilateral ptosis due to midbrain tuberculoma has not been previously reported.

  References Top

1.The localization of lesions affecting the ocular motor system. In : Brazis PW, Masdeu JC, Biller J. Localization in clinical neurology. 5 th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 175-9.  Back to cited text no. 1    
2.Conway VH, Rozdilsky B, Schneider RJ, Sundaram M. Isolated bilateral complete ptosis. Can J Ophthalmol 1983;18:37-40.  Back to cited text no. 2  [PUBMED]  
3.Chang DB, Lin YY, Guo WY, Wang S, Tsai CP, Lin KP, et al . Midbrain hemorrhage presenting as bilateral ptosis without hemiplegia: A case report. Zhonghua Yi Xue Za Zhi (Taipei) 1995;55:185-8.  Back to cited text no. 3  [PUBMED]  


  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Neuro-ophthalmic manifestations of tuberculosis
Rebika Dhiman, Subodh Lakra, Prateek Kumar Panda, Naren Hemachandran, Sanjay Sharma, Rohit Saxena
Eye. 2021;
[Pubmed] | [DOI]
2 Brainstem stroke presenting as isolated bilateral ptosis
Sunil James, Karunakaran Pradeep Thozhuthumparambil
BMJ Case Reports. 2021; 14(7): e243220
[Pubmed] | [DOI]
3 Isolated brainstem tuberculomas
Nishanth Sadashiva,Sarbesh Tiwari,Dhaval Shukla,Dhananjaya Bhat,Jitender Saini,Sampath Somanna,Bhagavatula Indira Devi
Acta Neurochirurgica. 2017; 159(5): 889
[Pubmed] | [DOI]
4 Brain stem tuberculoma presenting with isolated ocular motility abnormality: A series of two cases and review of literature
Sharma, K. and Kanaujia, V. and Jaiswal, S. and Jain, A. and Kumar, S. and Srivastava, A.K. and Jaiswal, A.K.
Oman Journal of Ophthalmology. 2012; 5(1): 61-63
5 Lateral medullary syndrome due to brain stem tuberculoma
Verma, R. and Sharma, P.
Journal of Association of Physicians of India. 2011; 59(6)
6 Unusual clinical presentation of tuberculoma
Verma, R. and Sharma, P.
Journal of Postgraduate Medicine. 2011; 57(2): 143-144


Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow