Presentation
Inability to upward gaze, developed one week prior.
Patient Data
Evidence of thickening and abnormal enhancement surrounding the left superior oblique tendon trochlear complex involving the superior oblique tendon and the anterior aspect of the muscle belly. Features are in keeping with acquired Brown's syndrome. Bilateral minimal maxillary and ethmoid sinusitis are noted. However no direct communication between the sinuses fluid and the inflamed area. No evidence of mass lesions in this region.
A cerebellar tonsillar herniation is noted (about 8.5 mm). No syrinx could be seen of the visualized cervical cord. No downward migration of brainstem or obex of medulla oblongata.
Annotated images of coronal T2 fat sat and T1 c+ fat-sat images show asymmetrically thickened left trochlear sling with increased signal intensity and enhancement after IV contrast administration.
Case Discussion
In this case, the cause was unknown.