This 31-year-old male presents with ptosis, mild diplopia, and slight head tilt suspected to be caused by myasthenia gravis. Does this diagnosis fit the clinical picture?
Analysis
Here, we see a patient with right ptosis, slight right hypotropia in primary position, and limitation of movement in the left field of the right inferior oblique. The remaining ocular and neurologic exam was unremarkable (including no findings of myasthenia gravis). This patient was diagnosed with right Brown syndrome with abnormal head posture and congenital ptosis.
Brown syndrome is caused by a tight superior oblique tendon that causes restriction of inferior oblique field by preventing the eye from elevating upwards. Brown syndrome can be either congenital or acquired; congenital forms tend to be asymptomatic due to compensatory mechanisms.
In this 13-minute video featuring Dr. Paul Freund, Assistant Professor at Dalhousie University in Halifax, you will learn:
- Learn how to identify Brown syndrome and differentiate it from other similar presentations
- Review various etiologies of Brown syndrome
- Review treatments for Brown syndrome in both adults and children
Neuro Coach Tip
Not every non-cranial nerve palsy motility defect is myasthenia gravis or thyroid eye disease; it is important to avoid anchoring and availability biases when making clinical decisions.
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