Affiliations: [a] Département des Neurosciences cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland | [b] Département des Neurosciences cliniques, Unité de Neuro-Réhabilitation Aigüe, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland | [c] Unité de Neuro-Ophtalmologie, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland
Correspondence:
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Address for correspondence: Julien Dimitriou, Département de Neurosciences Cliniques, Service de Neurochirurgie, CentreHospitalier Universitaire Vaudois, Lausanne, Switzerland. Tel.: +41 7966 63039; Fax: +41 2131 42595; jdimi84@gmail.com
Abstract:
BACKGROUND: Bilateral ptosis is a very interesting clinical challenge for doctors because of the multiple possible localizations of a lesion which can lead to this neurological sign.
OBJECTIVES: Through this case report, we aim to determine the difference between an apraxia of lid opening (ALO) with difficulty in initiating the act of lid elevation, in spite of adequate understanding, motor control and cranial nerve pathways, and a bilateral ptosis with a lesion in the oculomotor nucleus or blepharospasm.
METHODS: The case report of a 50-year-old patient presenting bilateral ptosis and multiple ischemic lesions in the brainstem and bilateral frontal lobe lesions after the emergency removal of a large frontal tumor.
RESULTS: Our patient had an ALO according to the neurological follow-up and showed the ability, after a few weeks, of initiating the act of opening her eyes with her hand. The ophthalmic evaluation confirmed that in her case the ALO was associated with a nuclear lesion of the oculomotor nerve secondary to a midbrain lesion.
CONCLUSION: Our case report confirms multiple differential diagnoses in bilateral ptosis and the importance of clinical examination in spite of good neurological imaging.
