Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Optom Vis Sci. 2023 Dec 1;100(12):895-899. doi: 10.1097/OPX.0000000000002089. Epub 2023 Nov 27.
Determining the anatomic location of insult in cases of concurrent bilateral upgaze palsy with bilateral ptosis can be challenging because of the various overlapping pathways and shared functions. It is more commonly related to bilateral oculomotor nerve palsies and myasthenia gravis. However, the possibility of unilateral cerebrovascular events may be overlooked because of the lack of laterality of disease manifestations.
This report documents the uncommon presentation of bilateral ptosis and upgaze palsy in unilateral hemispheric hemorrhage with the corresponding clinical and anatomical review.
A 46-year-old gentleman presented to the emergency department with left-sided hemiplegia, concurrent bilateral ptosis, and upgaze palsy. He was found to have acute hemorrhagic stroke secondary to significantly elevated blood pressure. Computed tomography of the brain revealed acute extensive intraparenchymal hemorrhage involving the right basal ganglia, frontal lobe, and temporal lobe. There was an extension of hemorrhage into the third ventricle and subarachnoid extension to the Sylvian fissure with obstructive hydrocephalus. An emergency right craniotomy was performed to evacuate the blood clot, and the hydrocephalus subsequently resolved. Post-operatively, bilateral ptosis and upgaze palsy improved and then resolved.
Acute bilateral ptosis and upgaze palsy suggest the possibility of unilateral hemispheric hemorrhage, even though there is no direct involvement of the brainstem and its nuclei.
在双侧上睑下垂伴双侧动眼神经麻痹的情况下，确定损伤的解剖位置具有挑战性，因为存在多种重叠的途径和共同的功能。它更常见于双侧动眼神经麻痹和重症肌无力。然而，由于疾病表现缺乏侧化，单侧脑血管事件的可能性可能被忽视。
本报告记录了单侧半球性出血中罕见的双侧上睑下垂和上视肌麻痹表现，并进行了相应的临床和解剖学复习。
一位 46 岁的男士因左侧偏瘫、双侧上睑下垂和上视肌麻痹而到急诊科就诊。他被发现患有因血压显著升高引起的急性出血性中风。脑部计算机断层扫描显示右侧基底节、额叶和颞叶广泛急性脑实质内出血。出血延伸至第三脑室，并向大脑外侧裂蛛网膜下腔延伸，导致阻塞性脑积水。紧急行右侧开颅术以清除血肿，随后脑积水得到解决。术后，双侧上睑下垂和上视肌麻痹改善并最终恢复。
急性双侧上睑下垂和上视肌麻痹提示单侧半球性出血的可能性，即使脑干及其核团没有直接受累。
