Inferior oblique muscle paresis as a sign of myasthenia gravis

Almog, Yehoshua; Ben‐David, Merav; Nemet, Arie Y.

doi:10.1016/j.jocn.2015.08.026

Cited by 22 publications

(17 citation statements)

References 21 publications

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“…MG, hastaların %75'inde diplopi bulanık görme ve kapak düşüklüğü gibi oküler belirti ve bulgularla başlamaktadır. [3][4][5] Ekstraoküler kasların yapısal, fizyolojik ve immünolojik bazı özelliklerinin miyastenik tutulum açısından yatkınlık oluşturduğu yapılan araştırmalarla gösterilmiştir. [6][7][8] OMG'nin pupil tutulumu olmayan her türlü okülomotor sinir felcini, supranükleer ve internükleer bakış parezilerini taklit edebileceği bilinmektedir.…”

Section: Discussionunclassified

“…[6][7][8] OMG'nin pupil tutulumu olmayan her türlü okülomotor sinir felcini, supranükleer ve internükleer bakış parezilerini taklit edebileceği bilinmektedir. 5,9 Ayrıca OMG'nin komitan kayma şeklinde başladığı hastalar da bildirilmiştir. 10 Cleary ve ark.…”

Section: Discussionunclassified

“…Bunun yanında, Almog ve ark., alt oblik adalenin OMG'de en sık (%63) etkilenen adale olduğunu, izole alt oblik tutulumlarında da akla ilk önce OMG'nin gelmesi gerektiğini ileri sürmüşlerdir. 5 OMG'de izole SO tutulumu oldukça nadir bildirilmektedir. Cleary ve ark.nın 49 hastalık serisinde, sadece bir hastada izole SO tutulumu gözlenmiştir.…”

Section: Discussionunclassified

“…12 Almog'un OMG'li 30 hastalık serisinde ise üç hastada SO adalenin de etkilendiği bildirilmektedir. 5 SO oblik adale, orbita manyetik rezonans görüntüleme çalışmalarında en küçük kesitsel alana sahip ekstraoküler adaledir. 13 Kasın gücünün kesitsel alanı ile korelasyon gösterebileceği mantığından yola çıkıldığında, SO adalenin OMG'de en hassas kas olabileceği sonucuna varılabilir.…”

Section: Discussionunclassified

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Ocular Myasthenia Gravis Mimicking Superior Oblique Palsy

Koç¹,

Akbalik²

2020

Turkiye Klinikleri J Ophthalmol

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ÖZET Bu çalışmada, sırasıyla tek ve çift taraflı superior oblik felcini taklit eden bir oküler miyastenia gravis olgusu sunularak, superior oblik felcinin ayırıcı tanısında oküler miyastenia gravisın dikkate alınması gerektiği vurgulanmak istenmiştir. Bir yıldır devam eden çift görme şikâyeti olan 53 yaşındaki erkek olgu, sağ superior oblik felci tanısı almış ve cerrahi planlanmıştı. İkinci bir görüş için gelen olguya primer pozisyonda sol intermittan hipertropya ve ekzotropya saptandı ve üç basamak testi ile bilateral superior oblik felci tanısı konuldu. Subjektif torsiyon yoktu, ancak çift Maddox testinde 10°ekstorsiyon saptandı. Takipte, üç ay içinde göz hareketleri tüm yönlerde kısıtlanma ve sağ pitozis gelişti. Pupil tutulumu olmayan hastada bu bulgularla oküler miyastenia gravisten şüphe edildi. Pitozisin buz testi ile tamamen düzelmesi ile oküler miyastenia gravis tanısı konuldu. Superior oblik felci, vertikal şaşılığın en sık izlenen nedenidir. Ancak ayırıcı tanıda oküler miyastenia gravis akılda tutulmalı ve klinik stabilite gözlemlenmeden tedavi planlanmamalıdır. Anah tar Ke li me ler: Diplopi; miyastenia gravis; superior oblik felci ABS TRACT We aimed to draw attention to ocular myasthenia gravis to be considered in the differential diagnosis of superior oblique palsy by presenting a case who mimicked both unilateral and bilateral superior oblique palsy. A 53-year old male patient with a history of double vision for one year was diagnosed as having right superior oblique palsy and was planned for surgery. He came for the second opinion. Left intermittent hypertropia and exotropia was detected in the primary position and bilateral superior oblique palsy was diagnosed with three-step test. There was no subjective torsion, but a 10° extorsion was detected in the double Maddox test. In followup less than three months, eye movements restricted in all directions and right ptosis developed. The patient had no pupil involvement. ocular myasthenia gravis was diagnosed after observing complete resolution of ptosis with ice-pack test. Superior oblique paralysis is the most common cause of vertical strabismus. However, ocular myasthenia gravis should be kept in mind in the differential diagnosis and treatment should not be planned without clinical stability.

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Section: Discussionunclassified

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Ocular Myasthenia Gravis Mimicking Superior Oblique Palsy

Koç¹,

Akbalik²

2020

Turkiye Klinikleri J Ophthalmol

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“…La fréquence de la participation de chaque muscle extra-oculaire n'est pas bien établie dans la littérature. D'après une récente étude [2] comportant 30 patients ayant un diagnostic clinique de myasthénie avec atteinte des muscles extra-oculaires et diplopie, le muscle oblique inférieur a été impliqué plus souvent que tout autre muscle (63,3 %). Dix-huit (60 %) patients avaient un ptosis, dont six (20 %) d'entre eux avaient un ptosis bilatéral.…”

Section: Potentiels éVoqués Vestibulaires Myogéniques Oculairesunclassified

Clinique

2016

Cah. Myol.

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Clinical and imaging clues to the diagnosis and follow‐up of ptosis and ophthalmoparesis

Keene

Kan

Meeren

et al. 2022

J cachexia sarcopenia muscle

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Ophthalmoparesis and ptosis can be caused by a wide range of rare or more prevalent diseases, several of which can be successfully treated. In this review, we provide clues to aid in the diagnosis of these diseases, based on the clinical symptoms, the involvement pattern and imaging features of extra‐ocular muscles (EOM). Dysfunction of EOM including the levator palpebrae can be due to muscle weakness, anatomical restrictions or pathology affecting the innervation. A comprehensive literature review was performed to find clinical and imaging clues for the diagnosis and follow‐up of ptosis and ophthalmoparesis. We used five patterns as a framework for differential diagnostic reasoning and for pattern recognition in symptomatology, EOM involvement and imaging results of individual patients. The five patterns were characterized by the presence of combination of ptosis, ophthalmoparesis, diplopia, pain, proptosis, nystagmus, extra‐orbital symptoms, symmetry or fluctuations in symptoms. Each pattern was linked to anatomical locations and either hereditary or acquired diseases. Hereditary muscle diseases often lead to ophthalmoparesis without diplopia as a predominant feature, while in acquired eye muscle diseases ophthalmoparesis is often asymmetrical and can be accompanied by proptosis and pain. Fluctuation is a hallmark of an acquired synaptic disease like myasthenia gravis. Nystagmus is indicative of a central nervous system lesion. Second, specific EOM involvement patterns can also provide valuable diagnostic clues. In hereditary muscle diseases like chronic progressive external ophthalmoplegia (CPEO) and oculo‐pharyngeal muscular dystrophy (OPMD) the superior rectus is often involved. In neuropathic disease, the pattern of involvement of the EOM can be linked to specific cranial nerves. In myasthenia gravis this pattern is variable within patients over time. Lastly, orbital imaging can aid in the diagnosis. Fat replacement of the EOM is commonly observed in hereditary myopathic diseases, such as CPEO. In contrast, inflammation and volume increases are often observed in acquired muscle diseases such as Graves' orbitopathy. In diseases with ophthalmoparesis and ptosis specific patterns of clinical symptoms, the EOM involvement pattern and orbital imaging provide valuable information for diagnosis and could prove valuable in the follow‐up of disease progression and the understanding of disease pathophysiology.

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Inferior oblique muscle paresis as a sign of myasthenia gravis

Cited by 22 publications

References 21 publications

Ocular Myasthenia Gravis Mimicking Superior Oblique Palsy

Ocular Myasthenia Gravis Mimicking Superior Oblique Palsy

Clinique

Clinical and imaging clues to the diagnosis and follow‐up of ptosis and ophthalmoparesis

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