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The child with divergence paresis
B Schanzer1, M Bordaberry, A R Jeffery
1John F. Kennedy Medical Center, Edison, New Jersey, USA.
Survey of Ophthalmology
|June 23, 1998
Summary
Divergence paralysis, a rare condition causing inward eye turning, can be linked to serious neurological issues. This case highlights a large pontomedullary glioma as a cause in a teenage patient.
Area of Science:
- Ophthalmology
- Neurology
- Pediatric Neurology
Background:
- Divergence paralysis is a rare clinical finding characterized by comitant esotropia (inward turning of the eyes) when viewing distant objects.
- While often benign and self-resolving, it can be associated with significant underlying neurological conditions.
Observation:
- A 14-year-old female presented with a chief complaint of diplopia (double vision).
- Clinical examination confirmed the presence of divergence paralysis.
Findings:
- Magnetic resonance imaging (MRI) revealed a large pontomedullary glioma.
- This finding establishes a direct link between the patient's divergence paralysis and a significant brain tumor.
Implications:
- This case underscores the importance of thorough neurological investigation in patients presenting with divergence paralysis, even in younger individuals.
- It highlights pontomedullary gliomas as a potential, albeit rare, cause of this ophthalmological sign.
- Early diagnosis and management of underlying causes like brain tumors are crucial for favorable outcomes.