Dr. JAYASRI KANTHALU NARAYANAMOORTHY
ABSTRACT: A 12 year old boy presented to us with 2 months history of intermittent bilateral ptosis and diplopia which was initially diagnosed as ocular myasthenia after clinical investigations and treated accordingly. After few days he developed headache and vomiting. Neurological examination showed presence of bilateral ptosis with normal pupils, upgaze restriction and papilloedema. MRI Brain and MR Spectroscopy showed multiple tuberculoma, involving cerebellar vermis, midbrain including tectal plate and periaqueductal region with obstructive hydrocephalus. With anti tubercular drugs and conservative therapy, the response was found to be dramatic. Brain stem tuberculoma are rare lesions and account for about 5% of all intra cranial tuberculoma. Bilateral ptosis with upgaze restriction as the initial presenting feature of brain stem tuberculoma is very rare. So tuberculoma of brain masquerading as ocular myasthenia with false positive clinical test is unique and hence reportable.
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