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Ptosis in patients with hemispheric strokes

L. Averbuch-Heller, MD^;, R. J. Leigh, MD;, V. Mermelstein, MD;, L. Zagalsky, MD; and J. Y. Streifler, MD

Deceased.
From the Departments of Neurology (Drs. Averbuch-Heller, Mermelstein, Zagalsky, and Streifler) and Ophthalmology (Dr. Averbuch-Heller), Rabin Medical Center, Petach Tikva and Tel Aviv University, Israel; and Department of Neurology (Dr. Leigh), Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH.

Address correspondence and reprint requests to Dr. Jonathan Y. Streifler, Neurology Unit, Rabin Medical Center, Golda Campus, 7 Keren Kayemet St., Petach Tikva 49372, Israel; e-mail: jonathans{at}clalit.org.il

Background: Cerebral ptosis is considered rare; it has been reported with unilateral, usually right hemispheric lesions. However, the frequency of cerebral ptosis in patients with strokes has not received systematic study.

Objective: To determine the frequency of ptosis in patients with acute hemispheric stroke and to identify stroke features associated with ptosis.

Methods: Eyelid function was studied in 64 consecutive patients with acute hemispheric stroke and 40 age-matched subjects with no known neurologic disease. All underwent comprehensive neuro-ophthalmologic and general neurologic examination within 48 hours of admission, including measurement of palpebral fissures, marginal reflex distance, and range of upper lid movement. Only patients who could cooperate with eyelid testing were included. Brain CT scans were obtained for all patients who had had strokes.

Results: Twenty-four (37.5%) of the patients with strokes had neurogenic ptosis, which was bilateral in 10 and unilateral in 14. None of the control subjects had neurogenic ptosis. All patients with strokes with ptosis had a hemiparesis. Rightward gaze deviation and upgaze paresis were more common (p < 0.05) in the patients with ptosis compared with others who had had strokes. CT evidence of right-sided hemispheric cortical infarction was more common in patients with strokes with ptosis (p < 0.05). In five patients with large hemispheric infarction, complete bilateral or asymmetric ptosis was the first sign of imminent herniation, preceding pupillary dilation and ocular motor deficits.

Conclusions: Ptosis occurs frequently in patients with hemispheric strokes, especially in association with right hemispheric lesions. Complete bilateral ptosis is usually caused by large infarctions and may be a premonitory sign of an impending herniation.

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				O. Lanczik, K. Szabo, J. Wohrle, J. Binder, M. Hennerici, K.-P. Park, K.-D. Choi, G. Y. Chang, J. Y. Streifler, and R. J. Leigh Ptosis in patients with hemispheric strokes Neurology, February 25, 2003; 60(4): 726 - 726. [Full Text] [PDF]

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