Two Cases with Positive Ice Tests Mimicking Ocular Myasthenia Gravis.

Seo, Eoi Jong; Park, Aram; Chung, Seung Ah

doi:2015.56.2.309

J Korean Ophthalmol Soc > Volume 56(2); 2015 > Article

Case Report

Journal of the Korean Ophthalmological Society 2015;56(2):309-315.
DOI: https://doi.org/10.3341/jkos.2015.56.2.309 Published online February 15, 2015.

Two Cases with Positive Ice Tests Mimicking Ocular Myasthenia Gravis.

Eoi Jong Seo, Aram Park, Seung Ah Chung

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea. mingming8@naver.com

얼음검사 양성을 보인 비-눈근육무력증 2예

서의종⋅박아람⋅정승아

아주대학교 의과대학 안과학교실

Abstract

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.

Key Words: Anti-nuclear antibody;Ice test;Myasthenia gravis;Oculomotor nerve palsy