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Unilateral proptosis: a diagnostic clinical and neuroimaging challenge

Alexandra Tzoukeva, Ara Kaprelyan, Nadezhda Deleva, Kiril Hristozov, Boyan Balev


INTRODUCTION: The differential diagnosis of unilateral proptosis includes tumors, infections often related with immunological process, trauma, vascular diseases or axial myopia.

CASE REPORTS: We present two patients with unilateral proptosis. A 34-yeard old caucasian man with a 3-months history of proptosis of the left eye with diplopia and normal visual acuity; initial CT scan examination showed highly suggestive finding for orbital apex tumor or glioma of the optic nerve, but a second CT scan with complementary projections was performed and a highly swollen inferior rectus muscle simulating an orbital apex tumor was visible. A diagnosis of unilateral thyroid ophthalmopathy was made. A 56-year old caucasian woman with unilateral exophthalmus and medical history of Graves’ hyperthyroidism; previously Graves’ ophthalmopathy was suggested. Fundoscopy showed myopic fundus. The CT scan revealed normal extraocular muscles without swollen.

CONCLUSION: These two cases of unilateral proptosis are described because of their clinical and radiological differential diagnosis. We suggest that the accurate diagnosis of a unilateral proptosis remains a big challenge to the neuroophthalmologist, endocrinologist, immunologist, neurosurgeon and radiologist.


unilateral proptosis, orbital apex tumor, optic nerve glioma, axial myopia, thyroid ophthalmopathy

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About The Authors

Alexandra Tzoukeva
Medical University of Varna

Department of Neurology, Faculty of Medicine

Ara Kaprelyan
Medical University of Varna

Department of Neurology, Faculty of Medicine

Nadezhda Deleva
Medical University of Varna

Department of Neurology, Faculty of Medicine

Kiril Hristozov
Medical University of Varna

Department of Endocrinology, Faculty of Medicine

Boyan Balev
Medical University of Varna

Department of Radiology, Faculty of Medicine

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