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Transient traumatic isolated neurogenic ptosis after a mild head trauma: a case report.

Li G, Zhang Y, Zhu X, Hou K - BMC Ophthalmol (2015)

Bottom Line: Further radiological investigation revealed nothing remarkable except for a fracture of the superior portion of the right medial orbital wall.She was managed conservatively and recovered completely in two months.The proposed mechanism is injury of the terminal branch of the superior division of the oculomotor nerve.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, The First Hospital of Jilin University Changchun, Changchun, Jilin, China. Gretchen666@yeah.net.

ABSTRACT

Background: Transient traumatic isolated neurogenic ptosis (TTINP) is a sporadically reported rare entity. However, to the best of our knowledge, nearly all the reported cases are either secondary to direct periorbital trauma or surgery. We would like to report on a case of TTINP with countre-coup injury of the periorbital region.

Case presentation: A 49-year-old female slipped and fell down while walking. She was hospitalized with a moderate headache and undisturbed mental state. The patient recalled that the force bearing point was her occipital region. Physical examination and computed tomography (CT) on admission showed right isolated ptosis and mild contusion and laceration in the bilateral frontal cortex. Further radiological investigation revealed nothing remarkable except for a fracture of the superior portion of the right medial orbital wall. She was managed conservatively and recovered completely in two months.

Conclusion: TTINP might manifest as a unique entity with a relatively mild, reversible, and non-devastating injury to the terminal branch of the oculomotor nerve and for which perhaps no special treatment is needed. The proposed mechanism is injury of the terminal branch of the superior division of the oculomotor nerve.

No MeSH data available.


Related in: MedlinePlus

A computed tomography scan revealed a mild bilateral contusion and laceration in the frontal poles (a) and a fracture of the superior portion of the right medial orbital wall (arrow head) (b)
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Fig1: A computed tomography scan revealed a mild bilateral contusion and laceration in the frontal poles (a) and a fracture of the superior portion of the right medial orbital wall (arrow head) (b)

Mentions: A 49-year-old female slipped and fell down while walking. Two hours later, the patient was hospitalized (The First Hospital of Jilin University, Changchun, China) with a moderate headache. A computed tomography (CT) (Fig. 1a) performed on admission showed a mild contusion and laceration in the bilateral frontal cortex. The patient was undisturbed in mental state through the accident and recalled that the force bearing point was her occipital region. Physical examination results were unremarkable except a right complete ptosis and swelling and contusion of the occipital region. The patients’ bilateral upper eyelids were gradually bruised in two days after the fall (Fig. 2a). The patients’ Glasgow Coma Scale score was 15. She denied alteration of her vision. The ophthalmic examination showed normal extraocular motility and pupillary responses without anisocoria (Fig. 2b-d). High-resolution CT images showed a fracture of the superior portion of the right medial orbital wall (Fig. 1b). Further magnetic resonance imaging and CT angiography revealed no other intracranial or intraorbital lesion that may be responsible for her ptosis. The patient was administered Haemocoagulase Agkistrodon (KONRUNS Pharmaceutical Co., Ltd., Beijing, China) intravenously for hemostasis in the initial three days (2U once daily) and Deproteinized Calf Blood Extractives (Harbin Sanctity Pharmaceutical Co., Ltd., China) (1.2 g once daily) intravenously for neuroprotection for 14 days. Some unspecified analgesic medications were also administered intermittently. Fourteen days later, the patient was discharged from the hospital with obvious remission of headache. However, the right ptosis persisted with levator function of 5 mm (left levator function was 14 mm). During outpatient follow-up, it was found that the right levator function was the same as the left-side except an indistinct upper eyelid crease in the fourth week after the accident (Fig. 2e). The patient’s eyelid crease became normal at two months after the hospital discharge. One year follow-up showed no recurrence of eyelid dysfunction.Fig. 1


Transient traumatic isolated neurogenic ptosis after a mild head trauma: a case report.

Li G, Zhang Y, Zhu X, Hou K - BMC Ophthalmol (2015)

A computed tomography scan revealed a mild bilateral contusion and laceration in the frontal poles (a) and a fracture of the superior portion of the right medial orbital wall (arrow head) (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4638091&req=5

Fig1: A computed tomography scan revealed a mild bilateral contusion and laceration in the frontal poles (a) and a fracture of the superior portion of the right medial orbital wall (arrow head) (b)
Mentions: A 49-year-old female slipped and fell down while walking. Two hours later, the patient was hospitalized (The First Hospital of Jilin University, Changchun, China) with a moderate headache. A computed tomography (CT) (Fig. 1a) performed on admission showed a mild contusion and laceration in the bilateral frontal cortex. The patient was undisturbed in mental state through the accident and recalled that the force bearing point was her occipital region. Physical examination results were unremarkable except a right complete ptosis and swelling and contusion of the occipital region. The patients’ bilateral upper eyelids were gradually bruised in two days after the fall (Fig. 2a). The patients’ Glasgow Coma Scale score was 15. She denied alteration of her vision. The ophthalmic examination showed normal extraocular motility and pupillary responses without anisocoria (Fig. 2b-d). High-resolution CT images showed a fracture of the superior portion of the right medial orbital wall (Fig. 1b). Further magnetic resonance imaging and CT angiography revealed no other intracranial or intraorbital lesion that may be responsible for her ptosis. The patient was administered Haemocoagulase Agkistrodon (KONRUNS Pharmaceutical Co., Ltd., Beijing, China) intravenously for hemostasis in the initial three days (2U once daily) and Deproteinized Calf Blood Extractives (Harbin Sanctity Pharmaceutical Co., Ltd., China) (1.2 g once daily) intravenously for neuroprotection for 14 days. Some unspecified analgesic medications were also administered intermittently. Fourteen days later, the patient was discharged from the hospital with obvious remission of headache. However, the right ptosis persisted with levator function of 5 mm (left levator function was 14 mm). During outpatient follow-up, it was found that the right levator function was the same as the left-side except an indistinct upper eyelid crease in the fourth week after the accident (Fig. 2e). The patient’s eyelid crease became normal at two months after the hospital discharge. One year follow-up showed no recurrence of eyelid dysfunction.Fig. 1

Bottom Line: Further radiological investigation revealed nothing remarkable except for a fracture of the superior portion of the right medial orbital wall.She was managed conservatively and recovered completely in two months.The proposed mechanism is injury of the terminal branch of the superior division of the oculomotor nerve.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, The First Hospital of Jilin University Changchun, Changchun, Jilin, China. Gretchen666@yeah.net.

ABSTRACT

Background: Transient traumatic isolated neurogenic ptosis (TTINP) is a sporadically reported rare entity. However, to the best of our knowledge, nearly all the reported cases are either secondary to direct periorbital trauma or surgery. We would like to report on a case of TTINP with countre-coup injury of the periorbital region.

Case presentation: A 49-year-old female slipped and fell down while walking. She was hospitalized with a moderate headache and undisturbed mental state. The patient recalled that the force bearing point was her occipital region. Physical examination and computed tomography (CT) on admission showed right isolated ptosis and mild contusion and laceration in the bilateral frontal cortex. Further radiological investigation revealed nothing remarkable except for a fracture of the superior portion of the right medial orbital wall. She was managed conservatively and recovered completely in two months.

Conclusion: TTINP might manifest as a unique entity with a relatively mild, reversible, and non-devastating injury to the terminal branch of the oculomotor nerve and for which perhaps no special treatment is needed. The proposed mechanism is injury of the terminal branch of the superior division of the oculomotor nerve.

No MeSH data available.


Related in: MedlinePlus