Ptosis in patients with hemispheric strokes

Abstract

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.

Ipsilateral Ptosis Associated with Anterior Thalamic Infarction

“…The higher frequency of ptosis following right compared to left hemisphere lesions has been explained by the hypothesis that the supranuclear center in the right precentral cortex is dominant over the supranuclear center in the left precentral cortex [8][9][10] . However, other studies found that cerebral ptosis can occur asymmetrically or unilaterally in ipsilateral or contralateral levator palpebrae and following left as well as right hemisphere injury [1,2] . Thus, as has been postulated, anatomic variants may exist such that 'the central caudal nucleus of the levators has separate neuronal pools segregated for the right and left eye lids' [2,10] or the premotor control of the levator palpebrae is at least in part lateralized.…”

“…Cerebral ptosis is more frequent after right than left hemispheric strokes, and its frequency has been reported to be up to 37.5% [2] . Anterior thalamic infarction causes hemi-sensory or motor defi cits as well as cognitive decline such as amnesia and frontal dysfunction [3] .…”

“…At discharge (8 days after stroke), his motor weakness, facial palsy and dysarthria had disappeared, but the right ptosis and cognitive defi cits persisted. The ptosis still remained unchanged at 10 months after stroke.Any damage to the supranuclear motor circuits that supply the levator palpebrae can result in what has been termed 'cerebral ptosis' [1,2] . Cerebral ptosis is more frequent after right than left hemispheric strokes, and its frequency has been reported to be up to 37.5% [2] .…”

Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling

“…It may appear de novo in deteriorating patients. [36][37][38] Despite several attempts to date, 39,40 no clinical feature has been validated to reliably measure level of consciousness in this setting, nor has there been a good way of documenting the early changes in level of consciousness. (In several recent studies evaluating decompressive craniectomy, only item 1a of the National Institutes of Health Stroke Scale has been used to link decreased level of consciousness to brain swelling.)…”

Oskar Kokoschka and Auguste Forel

“…However, although classical teaching suggests that this may be an outcome of stroke, there is a body of evidence that ptosis may occur on the affected side in up to one third of hemiparetic strokes. 25 It is likely that this combination of circumstances that portrayed Forel at his most vulnerable, combined with the occult disease, fired the intuitive observation and artistic vision of the artist. The qualities that Kokoschka describes as integral to the art of painting are also those of clinical medicine.…”