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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 232-233

Complete Bilateral Ptosis: An Early Clinical Sign of Herniation in Right Hemispheric Infarction


1 Senior Consultant Neurologist and Stroke Specialist, Apollo Hospitals, Opposite I.I.M-B, Bannerghatta Road, Bangalore, Karnataka, India
2 Department of Neurology, M.S. Ramaiah Medical College, M.S.R.I.T Post, Bangalore, Karnataka, India

Date of Submission23-Apr-2017
Date of Decision16-Jul-2020
Date of Acceptance06-Aug-2020
Date of Web Publication24-Feb-2021

Correspondence Address:
Suryanarayana Sharma
Senior Consultant Neurologist and Stroke Specialist, Apollo Hospitals, Opposite I.I.M-B, Bannerghatta Road, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.310085

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How to cite this article:
Sharma S, Mahendra J V, A John A J, Mehta A, Srinivasa R. Complete Bilateral Ptosis: An Early Clinical Sign of Herniation in Right Hemispheric Infarction. Neurol India 2021;69:232-3

How to cite this URL:
Sharma S, Mahendra J V, A John A J, Mehta A, Srinivasa R. Complete Bilateral Ptosis: An Early Clinical Sign of Herniation in Right Hemispheric Infarction. Neurol India [serial online] 2021 [cited 2021 Apr 11];69:232-3. Available from: https://www.neurologyindia.com/text.asp?2021/69/1/232/310085





  Case Summary Top


Complete bilateral ptosis (CBP) has been described in massive right Hemispheric lesions.[1] This 49-years-old gentleman presented with left hemiparesis of 4 h duration. CT Brain was done and he was thrombolyzed with r-TPA. Serial neuroimages are shown in [Figure 1]. The patient developed CBP at 24 h, repeat imaging revealed massive right MCA infarction with midline shift, decompression craniotomy was done at 30 h and CBP resolved completely on the second postoperative day [Figure 2]. He had residual hemiplegia and hemineglect at 90 days follow-up. CBP is a valuable clinical sign of massive right hemispheric lesion that precedes herniation providing an opportunity for early intervention.[2]
Figure 1: (a) CT Brain showing loss of insular ribbon. (b-d) MRI Brain at 16 h showing acute right MCA infarction. (e) CT Brain at 24 h revealing hemorrhagic transformation, mass effect and midline shift. (f and g) CT brain on second & seventh postoperative day. (h) CT brain at 90 days showing gliosis

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Figure 2: (a) Complete bilateral ptosis, (b) eye movements and pupillary reaction being normal, (c) moving right upper limb to commands, (d) Complete resolution of ptosis following decompression craniotomy

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Blacker DJ, Wijdicks EFM. Delayed complete bilateral ptosis associated with massive infarction of the right hemisphere. Mayo Clin Proc 2003;78:836-9.  Back to cited text no. 1
    
2.
Averbuch-Heller L, Leigh RJ, Mermelstein V, Zagalsky L, Streifler JY. Ptosis in patients with hemispheric strokes. Neurology 2002;58:620-4.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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