DR. ARYA WAKANKAR

Dr. UMESH HARAKUNI, DR. SHIVANAND BUBANALE, DR. BHAGYAJYOTHI B. K., DR. DHRUV GOYAL

Abstract

70 year old female presented with drooping of upper eyelid & diminution of vision in right eye since 10 days. She was a known hypertensive since 1 year on treatment.Vision was OD:PL+, PR accurate;OS:6/9.Right eye showed complete ptosis, 30°exotropia & partial restriction of all movements except abduction.Anterior segment showed RAPD & fundus showed disc pallor with grade 2 hypertensive changes.Extraocular movements,anterior & posterior segment normal in left eye.CNS examination showed unequal soft palate rise on right side,deviation of uvula to left & tongue deviation to right side.MRI Brain showed hypertensive ischemic changes in bilateral periventricular & subcortical white matter suggesting ischemic etiology leading to oculomotor,glossopharyngeal,vagus and hypoglossal nerve palsy.Conclusion:Microvascular nerve palsies have varied presentations & may rarely cause multiple cranial nerve involvement.Risk factors are HTN, DM, hypercholesterolemia.Often see good recovery in 8-12 weeks.