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KMID : 0360220150560020309
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Journal of the Korean Ophthalmological Society
2015 Volume.56 No. 2 p.309 ~ p.315
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Two Cases with Positive Ice Tests Mimicking Ocular Myasthenia Gravis
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Seo Eoi-Jong
Park A-Ram
Chung Seung-Ah
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Abstract
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Purpose: To report two patients with positive ice tests who had diplopia and blepharoptosis caused by something other than ocular myasthenia gravis.
Case summary: A 35-year-old female presented with a one-week history of inability to adduct the left eye and left blepharoptosis. Although the ice test was positive, serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Brain angiography showed an aneurysm of the left posterior communicating artery, leading to the diagnosis of left pupil-sparing oculomotor nerve palsy. A 25-year-old female presented with an 8-month history of intermittent horizontal diplopia and blepharoptosis in the right eye. The ice test was positive, however serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Anti-nuclear antibody was positive (titer 1:160).
Conclusions: The ice test is a useful screening test for myasthenia gravis. However, a series of differential diagnoses including blepharoptosis and ocular motility disorder should be considered because these conditions also show a positive result in the ice test.
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KEYWORD
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Anti-nuclear antibody, Ice test, Myasthenia gravis, Oculomotor nerve palsy
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