DR. JAYASRI KANTHALU NARAYANAMOORTHY

DR.MAHESH KUMAR S

Abstract

A 75-year-old female patient with known diabetes and hypertensive presented with sudden onset of both eyes drooping of upper lid and defective vision for 4 days. History of giddiness due to uncontrolled BP for that she was admitted and treated under Physician. On examination her BCVA of BE 6/12, bilateral ptosis with restriction of adduction, depression and elevation in BE. Pupil of RE mid dilated fixed and of LE sluggishly reacting to light. BE fundus was normal. Rest of cranial nerve examination were normal. Diagnosis of bilateral nuclear pupil involving third nerve palsy was made. MRI brain shows Mid brain hemorrhage involving periaqueductal gray matter including both side 3 rd. nerve nucleus (EWN nucleus) cause for bilateral third nerve palsy. She was referred to the Neurologist. Early diagnosis and treatment prevent the progression of disease and should save the life of the patient. This case report remains to be a valuable source of improving awareness amongst physicians.