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Brown’s syndrome: a rare cause of vertical diplopia
  1. Karamala Yalapalli Manisha1,
  2. Sruthi Sivaraman Nair1,
  3. Adarsh Anil Kumar2,
  4. Soumya Sundaram1
  1. 1 Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  2. 2 Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  1. Correspondence to Dr Soumya Sundaram; ssdr.soumya{at}gmail.com

https://doi.org/10.1136/pn-2023-004028

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    A 30-year-old woman had binocular vertical diplopia for 1 year, which worsened when looking to the left and looking up. There was no pain, and no history of ocular surgery, trauma, sinusitis or other systemic illnesses. On examination, her head was tilted to the left and her face was directed towards the right. She had mild hypotropia of the right eye in the primary position, marked restriction in elevation of the right eye in adduction and right eye downshoot in adduction (figure 1). The forced duction test was positive, confirming the diagnosis of Brown’s syndrome of right eye. MRI of the orbit and brain with contrast was normal (figure 2B). Evaluation for secondary causes by antinuclear antibody profile, serum antineutrophil cytoplasmic antibody, C reactive protein, serum ACE and IgG4, and thyroid function tests were normal.

    Figure 1

    (A-I) Ocular examination in the nine cardinal directions of gaze, showing (E) hypotropia of the …

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    Footnotes

    • Contributors KYM: study concept, design, acquisition of data and drafting of manuscript. SSN: concept of the study and critical revision of manuscript. AAK: acquisition of data. SS: drafting, supervision and critical revision of manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Luke Bennetto, Bristol, UK, and Susan Mollan, Birmingham, UK.

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