Curtains

• Published in: Survey of ophthalmology Vol. 57; no. 3; pp. 284 - 291
• Main Authors: Phillips, Paul H., MD, Angtuaco, Edgardo, MD, VanHemert, Rudy L., MD, Foroozan, Rod, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier
• Subjects: Biological and medical sciences; Blepharoptosis - etiology; Brain Diseases - diagnosis; cranial nerve III palsy; cryptococcal meningitis; Cryptococcus neoformans - isolation & purification; Diagnosis, Differential; diplopia; Diplopia - etiology; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Meningitis, Cryptococcal - complications; Meningitis, Cryptococcal - diagnosis; Middle Aged; Miscellaneous; Myasthenia Gravis - diagnosis; Oculomotor Nerve Diseases - etiology; Ophthalmology; ptosis; diplopia; cranial nerve III palsy; cryptococcal meningitis; ptosis; Ophthalmology
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/j.survophthal.2011.04.005

Abstract A 55-year-old immunocompetent man presented with headache, nausea, progressive bilateral upper lid ptosis, and diplopia. Examination showed bilateral asymmetric upper lid ptosis with limited adduction and elevation of both eyes. Cranial magnetic resonance imaging revealed enhancing intra-axial and extra-axial midbrain lesions. Blood and cerebrospinal fluid were positive for cryptococcal antigen and cerebrospinal fluid fungal cultures grew Cryptococcus neoformans . Treatment with liposomal amphotericin B and flucytosine resulted in complete resolution of his neurological deficits and lesions on neuroimaging. Patients with cryptococcal meningitis may rarely present with bilateral cranial nerve III dysfunction.