Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses
A 78-year-old woman complained of gradual, painless onset of horizontal binocular diplopia associated with progressive axial weakness. Physical examination revealed esotropia that was greater at distance than at near vision, bilateral levator dehiscence, and normal abducting saccadic speeds. Given t...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Ophthalmological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2017/1708734 |
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| author | Stephanie S. L. Cheung Larissa K. Ghadiali Thomas H. Brannagan III Gul Moonis Phyllis L. Faust Jeffrey G. Odel |
| author_facet | Stephanie S. L. Cheung Larissa K. Ghadiali Thomas H. Brannagan III Gul Moonis Phyllis L. Faust Jeffrey G. Odel |
| author_sort | Stephanie S. L. Cheung |
| collection | DOAJ |
| description | A 78-year-old woman complained of gradual, painless onset of horizontal binocular diplopia associated with progressive axial weakness. Physical examination revealed esotropia that was greater at distance than at near vision, bilateral levator dehiscence, and normal abducting saccadic speeds. Given the age of the patient and compatible clinical findings, the diagnosis of Sagging Eye Syndrome (SES) was made. However, further work-up with a muscle biopsy suggested Sporadic Late-Onset Nemaline Myopathy (SLONM) as the cause of her progressive muscle weakness. Although rare, external ophthalmoplegia has been described in the literature as a presenting symptom in SLONM. To elucidate the pathological mechanism for the patient’s diplopia, an MRI of the orbits was performed, which revealed findings consistent with SES. This case aims to highlight the importance of integrating clinical findings during the diagnostic process and serves as a reminder that diplopia can be a common symptom for an uncommon diagnosis. |
| format | Article |
| id | doaj-art-0ddb4c4b024249c5851b2485c1194897 |
| institution | Kabale University |
| issn | 2090-6722 2090-6730 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Ophthalmological Medicine |
| spelling | doaj-art-0ddb4c4b024249c5851b2485c11948972025-02-03T06:45:19ZengWileyCase Reports in Ophthalmological Medicine2090-67222090-67302017-01-01201710.1155/2017/17087341708734Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two DiagnosesStephanie S. L. Cheung0Larissa K. Ghadiali1Thomas H. Brannagan III2Gul Moonis3Phyllis L. Faust4Jeffrey G. Odel5Hospital Authority, Hong KongDepartment of Ophthalmology, Columbia University Medical Center, New York, NY, USADepartment of Neurology, Columbia University Medical Center, New York, NY, USADepartment of Radiology, Division of Neuroradiology, Columbia University Medical Center, New York, NY, USADepartment of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USADepartment of Ophthalmology, Columbia University Medical Center, New York, NY, USAA 78-year-old woman complained of gradual, painless onset of horizontal binocular diplopia associated with progressive axial weakness. Physical examination revealed esotropia that was greater at distance than at near vision, bilateral levator dehiscence, and normal abducting saccadic speeds. Given the age of the patient and compatible clinical findings, the diagnosis of Sagging Eye Syndrome (SES) was made. However, further work-up with a muscle biopsy suggested Sporadic Late-Onset Nemaline Myopathy (SLONM) as the cause of her progressive muscle weakness. Although rare, external ophthalmoplegia has been described in the literature as a presenting symptom in SLONM. To elucidate the pathological mechanism for the patient’s diplopia, an MRI of the orbits was performed, which revealed findings consistent with SES. This case aims to highlight the importance of integrating clinical findings during the diagnostic process and serves as a reminder that diplopia can be a common symptom for an uncommon diagnosis.http://dx.doi.org/10.1155/2017/1708734 |
| spellingShingle | Stephanie S. L. Cheung Larissa K. Ghadiali Thomas H. Brannagan III Gul Moonis Phyllis L. Faust Jeffrey G. Odel Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses Case Reports in Ophthalmological Medicine |
| title | Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses |
| title_full | Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses |
| title_fullStr | Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses |
| title_full_unstemmed | Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses |
| title_short | Sagging Eye Syndrome or Nemaline Rod Myopathy? Divergence Insufficiency with Levator Dehiscence as an Overlapping Symptom between Two Diagnoses |
| title_sort | sagging eye syndrome or nemaline rod myopathy divergence insufficiency with levator dehiscence as an overlapping symptom between two diagnoses |
| url | http://dx.doi.org/10.1155/2017/1708734 |
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