PMC9478739_01
Nine cardinal positions photo showing right blepharoptosis and anisocoria. The right
eye motility showed limited adduction, infraduction, abduction, and supraduction;
indicating 3rd, 4th, and 6th palsies.
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With the use of a cotton tip we found decreased right corneal sensation; sensorimotor testing showed external ophthalmoplegia of the right eye, indicating 3rd, 4th, and 6th right nerves palsies (Figure 1).
MRI of the brain with contrast. T1 post contrast axial cut (a) shows pre-chiamsatic
enhancement of the right optic nerve along with the nerve sheath, and enhancement of the
medial border of right temporal lobe. T1 post contrast coronal cut with fat saturation
(b) showed enhancement of the right optic nerve as it crosses the optic canal along with
patchy enhancement of the temporal lobe. Diffusion weighted imaging (c) demonstrates
patches of dark areas in the corresponding enhancing lesions.
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Therefore, the patient was investigated with a brain and orbital magnetic resonance imaging (MRI) with and without contrast that was done urgently and displayed pre-chiamsatic enhancement of the right optic nerve along with the nerve sheath, and enhancement of the medial border of right temporal lobe on T1 post contrast axial cut (Figure 2(a)), and this is also shown on coronal cut as the optic nerve crosses the optic canal (Figure 2(b)). Diffusion-weighted imaging obtained at the same level showed hypointensity, and corresponding mixed signal intensity on apparent diffusion coefficient images (Figure 2(c)).