Dr. Sonal Dua Juneja, D16060, Dr. Rakesh Juneja, Dr. Rashmin Gandhi, Dr. Prem Subramanian
Purpose: To promote the use of LP as routine Ix in cases of 3rd Nv. Palsy
Method: 55/y/M, H/o Low grade Fever since 7 days C/o Drooping of Rt eyelid with Rt eyeball deviated down & out associated with diplopia on manually elevating the eyelid since 4 days, sudden in onset, constant, unilateral. K/c/o DM Type II since 3 years on Rx at present. O/e: Va: OD-OS-6/24-6/18 with PH. Head turned to opposite side, face tilted towards same side with chin up lift, Drooping of Rt Lid, Bells Phenomenon: -ve, FDT: -ve. Diagnosed as Isolated U/L Pupil Sparing Diabetic Oculomotor Mono-neuropathy.
Result: Rx with anti-diabetics & antipyretics. DM contolled, mild fever persisted with no recovery. LP done, which revealed TB meningitis. ATT started. 3rd nerve palsy recovered in few weeks.
Conclusion: Every patient presenting with abrupt onset of 3rdnerve palsy, TB meningitis should be in the list of differential diagnosis & LP should be done in all, as the timing of Rx is crucial for prognosis.