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In general, intermittent diplopia evokes suspicion of ocular myasthenia gravis . However, other etiologies such as Brown syndrome or myokymia of the superior o blique may provoke intermittent diplopia. We present a case of intermittent dipl opia due to a tumor in the cavernous sinus. A 59-year-old patient reported int ermittent diplopia after prolonged downward gaze to the right. All other gaze di rections failed to provoke symptoms. In 1992, the diagnosis of inactive macroade noma of the pituitary gland was established and the patient underwent surgery an d radiation therapy. At physical examination, prolonged downward gaze to the rig ht of about 2 minutes provoked paresis of abduction, slight ptosis, and restrict ion of elevation on the left side, corresponding to sixth nerve palsy and palsy of the superior branch of the third nerve on the left side. MRI showed a relapse of the macroadenoma with infiltration of the cavernous sinus on the left side. The patient underwent surgery then focal radiation (gamma-knife). The clinical course was favourable and at the follow-up examination six months later, no dip lopia was reported.
In general, intermittent diplopia evokes suspicion of ocular myasthenia gravis. However, other etiologies such as Brown syndrome or myokymia of the superior o blique may provoke intermittent diplopia. A present a case of intermittent dipl opia due to a tumor in the cavernous sinus. A 59-year-old patient reported int ermittent diplopia after prolonged downward gaze to the right. All other gaze di rections failed to provoke symptoms. In 1992, the diagnosis of inactive macroade noma of the pituitary gland was established and the patient underwent surgery an d radiation therapy. At physical examination, prolonged downward gaze to rig ht of about 2 minutes provoked paresis of abduction, slight ptosis, and restrict ion of elevation on the left side, corresponding to sixth nerve palsy and palsy of the superior branch of the third nerve on the left side. MRI showed a relapse of the macroadenoma with infiltration of the cavernous sinus on the left side. The patient underwent surgery then The clinical course was favourable and at the follow-up examination six months later, no dip lopia was reported.