Bilateral Ptosis- A rare presentation of conversion disorder. A Case Report
Keywords:
ptosis, bilateral ptosis, conversion disorder, anxiety, ocular myastheniaAbstract
Background: Palpebral ptosis is defined as drooping of the upper eyelid due to partial or total reduction in the levatorpalpebrae function. Here we present a case of conversion disorder presenting as bilateral ptosis. Not much literature is available on the same.
Case Presentation: A 17-year-old girl presented to the Emergency Department complaining of bilateral drooping of the eyelids since morning, which was gradual in onset and progressive in nature. The primary survey was unremarkable. Neurological examination showed normal higher mental functions, normal sensations, normal deep tendon reflexes and normal muscle strength and tone. The diagnosis of factitious disorder was considered and the girl was diagnosed to have psychogenic pseudo ptosis. She was referred to the child psychiatry department, where after consultation, she was suspected to have conversion disorder. Subsequently, counselling sessions were started for her.
Conclusions: Some examples of conversion disorder include blindness, paralysis, dystonia, hallucinations, swallowing difficulties, motor ties, difficulty walking and dementia. However, the understanding of conversion disorder is still limited and not fully understood. The maximum incidence of conversion disorder is seen in children from 10-15 years and women, who have a 200% more chance of developing the disorder than men. Principally, the AChR antibody test, measuring the concentration of the antibody present, showed results that were higher by 0.01 nmol/L. The AChR antibody is the most common antibody found in Myasthenia Gravis patients. The anti-muscle specific kinase antibody (MuSK) test was also done but found to be negative. Electromyography tests were done which showed normal nerve conduction velocities similar to an earlier case report of a 14-year-old girl. Previous studies have shown full recovery in up to 90% of the patients with early diagnosis and treatment. Pseudo ptosis should be kept in mind in patients with psychiatric disorders after organic causes are ruled out.
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