Lagophthalmos- A Rare Presenting Sign in a Case of Childhood Pontine Glioma

Abstract

Brain stem glioma is a rare central nervous system tumour arising from glial cells which occur mostly in children. Diffuse Intrinsic Pontine Gliomas (DIPG) and Focal glioma are the two types of pontine glioma. DIPGs are highly aggressive. The clinical features are not the same in every child. It commonly has a grave prognosis as most children die within 18 months of diagnosis. Hereby, Authors present a case of 10-year-old male child complaining of watering from the left eye for four days. There was no history suggesting involvement of any other cranial nerves and there was no episode of any seizure or similar history. On examination patient was found to have left lagophthalmos. Magnetic Resonance Imaging (MRI) of brain showed features of pontine glioma with mass effect. To prevent exposure keratopathy, the child was started on lubricating drops/gel and lid taping and referred immediately to a cancer centre for further management. Patients with pontine gliomas usually complain of gait disturbance, headache, limb weakness and double vision. To Authors’ knowledge no other documented case has presented with lagophthalmos. This case is presented for the rarity of the presenting symptom and to stress the importance of picking early ophthalmic signs.