MRI of acquired Brown syndrome: a report of two cases

Lang, Min; Faraji, Navid; Coffey, Michael D.; Badve, Chaitra

doi:10.1016/j.radcr.2017.09.025

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…MRI in our case showed asymmetric thickening of the superior oblique tendon. Lang et al reported a similar MRI finding in 2 cases [ 11 ]. In our case, contrast could have shown better characterization of the superior oblique tendon, similar to that reported by Lang et al [ 11 ].…”

Section: Discussionmentioning

confidence: 63%

“…Lang et al reported a similar MRI finding in 2 cases [ 11 ]. In our case, contrast could have shown better characterization of the superior oblique tendon, similar to that reported by Lang et al [ 11 ]. Although spontaneous recovery has been previously reported in the literature [ 12 ], less invasive methods may be initially attempted to treat acquired Brown syndrome, such as local steroid injection or anti-inflammatory agents, as in our case [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 63%

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Brown Syndrome from Local Anesthesia for Inferior Orbital Fat Decompression

2020

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Patient: Female, 36-year-old Final Diagnosis: Acquired Brown syndrome Symptoms: Diplopia • vertical diplopia Medication: — Clinical Procedure: Local anesthesia • orbital fat decompression Specialty: Ophthalmology Objective: Unusual or unexpected effect of treatment Background: Vertical diplopia that follows local anesthesia is usually due to inferior rectus muscle fibrosis. Here, we report a rare case of acquired Brown syndrome following local anesthesia. Case Report: A 36-year-old woman underwent right inferior orbital fat decompression under local anesthesia. On the first postoperative day, she developed vertical diplopia. She had left hypertropia, which increased on left gaze, with limitation of elevation of the right eye on attempted adduction. Forced duction test of the right eye revealed resistance on elevation in adduction. Magnetic resonance imaging showed signal alteration, thickening, and irregularity involving the right superior oblique tendon and trochlea region. The diagnosis of iatrogenic Brown syndrome was made. Then, a single dose of 10 mg triamcinolone injection was given near the intratrochlear region. On follow-up, complete resolution of diplopia on primary gaze occurred 12 weeks after the incident. Conclusions: The reported case highlights that local anesthesia carries a risk of Brown syndrome. We believe bupivacaine-induced superior oblique hypertrophy is the underlying mechanism. The patient showed excellent outcome after medical management, with no surgical intervention required after 3 months of follow-up.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 63%

Brown Syndrome from Local Anesthesia for Inferior Orbital Fat Decompression

2020

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“…Lang et al postulates that idiopathic cases of Brown’s Syndrome may be due to subtle abnormalities of the superior oblique’s passage through the trochlea leading to local inflammation. 8 The etiology of Brown’s syndrome in this case was likely inflammatory given his steroid response and subtle MRI findings. Kushner suggested that cryptogenic cases of inflammatory Brown’s syndrome are best treated with injection of steroids into the trochlear area.…”

Section: Discussionmentioning

confidence: 80%

Late recurrence of idiopathic Brown’s syndrome successfully treated with oral corticosteroids

Micieli

2020

European Journal of Ophthalmology

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Introduction: Idiopathic Brown’s syndrome is a restrictive strabismus of the superior oblique tendon that often presents in pediatric populations and rarely occurs in adults. Case description: We present here a case of a 41-year-old man with an idiopathic left Brown’s syndrome that recurred after presenting with similar symptoms 14 years prior that was originally treated with oral corticosteroids. This patient had a negative work up for connective tissue disease and only exhibited subtle left trochlear thickening on orbital MRI with contrast. Since he had a good response to oral corticosteroids in the past, this repeat occurrence was treated with oral Prednisone and he promptly responded. His double vision resolved within 2 weeks and he continued to have a normal examination 6 months after presentation. Conclusion: We suspect this case was related to a subclinical inflammatory process resulting in the MRI findings and response to steroids. This case demonstrates that idiopathic Brown’s syndrome can recur more than a decade later in adults and oral corticosteroids are an effective treatment option even in the absence of an underlying rheumatological condition.

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“…The same ring-like enhancement is clearly discernible in the MRI of a patient with bilateral trochleitis in the context of adult-onset Still disease published by Gutmark et al (13). Further studies have previously identified enhancement of the trochlear region in acquired Brown syndrome (12,22–27). Elhusseiny et al used the term trochleitis in their case report of a patient with underlying juvenile idiopathic arthritis and contrast enhancement around the trochlea, where the typical limitation of extraocular movements as seen in Brown syndrome was missing.…”

Section: Discussionmentioning

confidence: 99%

The “Eyelet Sign” as an MRI Clue for Inflammatory Brown Syndrome

Fierz¹,

Landau²,

Kottke³

et al. 2021

Journal of Neuro-Ophthalmology

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Background: Brown syndrome is characterized by a restrictive elevation deficit of the affected eye in adduction. Besides the well-known congenital form, different acquired etiologies including inflammation, trauma, and surgery may prevent the superior oblique (SO) tendon from gliding freely through the trochlea on attempted upgaze. We present MRI findings in pediatric and adult patients with inflammatory acquired Brown syndrome. Methods: Retrospective review of clinical and MRI findings of 6 patients (4 children: median age 8.4 years [range 6.1-8.7]; 2 adults: age 46.4 and 51.1 years). Median follow-up was 23 months (range 1-52).Results: In all 6 patients, orbital MRI demonstrated inflammatory changes of the SO tendon-trochlea complex. A striking feature was circumferential contrast enhancement of the trochlea with central sparing where the tendon passes, reminiscent of an eyelet. In all cases, the motility restriction improved either spontaneously or with systemic antiinflammatory treatment. Although both adult patients had a history of known seronegative spondyloarthritis, there was no associated systemic condition in the children in our series. Conclusions: Both in children and in adults, MRI can provide evidence of inflammatory changes located at the trochlea-tendon complex in acquired Brown syndrome here referred to as the "eyelet sign," which may be helpful in confirming the clinical diagnosis and guide appropriate treatment.

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MRI of acquired Brown syndrome: a report of two cases

Cited by 6 publications

References 23 publications

Brown Syndrome from Local Anesthesia for Inferior Orbital Fat Decompression

Brown Syndrome from Local Anesthesia for Inferior Orbital Fat Decompression

Late recurrence of idiopathic Brown’s syndrome successfully treated with oral corticosteroids

The “Eyelet Sign” as an MRI Clue for Inflammatory Brown Syndrome

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