PMC5225697_01
An 11-year-old male child with bilateral symmetrical ptosis
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F1
Clinical examination revealed bilateral symmetrical ptosis [Figure 1], but the movement of both the eyeballs was normal in all the directions with normal pupillary size and reaction bilaterally.
Magnetic resonance imaging of brain (T1-weighted image; contrast-enhanced) showing single ring-enhancing lesion (yellow arrow) in the dorsal part of the midbrain with significant perifocal edema in adjacent part of brainstem, right cerebellar peduncle, adjacent thalamocortical tract, and periventricular region
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F2
Magnetic resonance imaging (MRI) of the brain revealed single ring-like enhancing lesion in the dorsal part of the midbrain with significant perifocal edema in adjacent parts of the brainstem, right cerebellar peduncle, adjacent thalamocortical tract, and periventricular region [Figure 2].
Magnetic resonance spectroscopy showing increased lipid peak, decreased N-acetylaspartate peak with increased Ch/Cr ratio, suggestive of tuberculoma
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F3
MRS at the site of the lesion showed increased lipid peak, decreased N-acetylaspartate (NAA) peak with increased choline/creatinine ratio, suggestive of tuberculoma [Figure 3].