Idiopathic unilateral third nerve palsy with pupillary sparring in 10-year-old child -a case report
Qaisar Ali Khan1, Sohail Adnan1, Naseer Ahmad1
1DHQ and Teaching Hospital KDA Kohat, Khyber, Pakhtunkhwa, Pakistan.
Insights
Idiopathic unilateral oculomotor nerve palsy in a child, presenting with ptosis and diplopia, showed improvement after treatment for mild anemia. This highlights the importance of considering systemic conditions in pediatric nerve palsies.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Unilateral oculomotor nerve palsy can stem from various causes including aneurysms, diabetes, CNS infections, pituitary tumors, and ischemia.
- Pediatric cases often present with symptoms like ptosis, diplopia, and eye movement restriction.
Observation:
- A 10-year-old child experienced right-sided ptosis, restricted eye movements, diplopia, and pain.
- Initial brain imaging and lab tests ruled out obstruction, infection, and hypercoagulable states, leading to an idiopathic diagnosis.
- The patient underwent a sling procedure for ptosis and was later diagnosed with mild anemia.
Findings:
- The child's condition, initially diagnosed as idiopathic third nerve palsy, improved significantly after a 4-month course of ferrous sulfate for mild anemia.
- This suggests a potential link between anemia and the resolution of oculomotor nerve palsy symptoms in this pediatric case.
Implications:
- Idiopathic third nerve palsy prognosis requires thorough patient counseling regarding surgical options.
- Comprehensive clinical evaluation, including detailed history and investigations, is crucial for diagnosing pediatric nerve palsies.
- Anemia should be considered as a potential contributing factor in pediatric cases of oculomotor nerve palsy.
Introduction And Importance:
Aneurysm, diabetes mellitus, central nervous system (CNS) infections, pituitary tumors, and ischemia alterations are all potential causes of unilateral oculomotor nerve palsy, a common clinical disease.
Case Presentation:
A 10-year-old child presented with right eyelid ptosis and restricted eye movements associated with diplopia and pain in the right eye. Brain imaging and laboratory tests revealed no obstruction, infection, or hypercoagulable state. The condition was labeled as idiopathic. A patient was diagnosed with ptosis through a sling procedure and after 2 and 4 weeks of follow-up was told he had mild anemia. The patient was prescribed ferrous sulfate 8mg once daily for 4 months and his condition improved.
Clinical Discussion:
Surgery can correct the appearance of crossed eyes, but it seldom restores or significantly improves binocular function. Amblyopia and the loss of binocular vision can occur in children with third nerve palsy due to the excessive angle of incitant strabismus and the resulting ptosis.
Conclusion:
Patients with idiopathic third nerve palsy must be informed of their prognosis so that they can make an informed decision about whether or not to undergo surgery. Clinical examination is the only way to identify a child's condition and proper investigations and a full history of prenatal and antenatal courses are required.
More Related Videos
10:10Full-Circle Cauterization of Limbal Vascular Plexus for Surgically Induced Glaucoma in Rodents
Published on: February 15, 2022
06:19Comparison of Three Clinical Stereoscopic Methods for Measuring Binocular Visual Function During Amblyopic Treatment in Unilateral Amblyopia
Published on: September 27, 2024