title: Isolated Unilateral Ptosis due to Paramedian Midbrain Infarction.
abstract: A 59-year-old man who had hypertension, dyslipidemia, diabetes mellitus, and left eye glaucoma developed sudden vertigo and left ptosis; he did not notice diplopia. He visited our hospital on day 3 after onset and neurologic examination showed left ptosis. His left visual acuity was counting fingers, and the light reflex was sluggish owing to glaucoma. Pupil sizes were equal, and eye movements and the lower lid were unremarkable. Magnetic resonance images revealed an acute infarction of the left paramedian midbrain. We considered that selective damage to the oculomotor fascicles innervating the left levator palpebrae superioris caused ipsilateral ptosis. As the fascicles for this ocular muscle run in the small area adjacent to those for the medial rectus, inferior rectus and superior rectus muscles, this is an extremely rare case of midbrain infarction presenting with isolated unilateral ptosis.
authors: Department of Neurology, National Hospital Organization Yokohama Medical Center, Yokohama City, Japan. Electronic address: ui.star11@gmail.com.
authors: Eriko
authors: E
authors: Sugawara
authors: Department of Neurology, National Hospital Organization Yokohama Medical Center, Yokohama City, Japan.
authors: Haruko
authors: H
authors: Nakamura
authors: Department of Neurology, National Hospital Organization Yokohama Medical Center, Yokohama City, Japan.
authors: Masanao
authors: M
authors: Endo
authors: Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama City, Japan.
authors: Fumiaki
authors: F
authors: Tanaka
authors: Department of Neurology, National Hospital Organization Yokohama Medical Center, Yokohama City, Japan.
authors: Tatsuya
authors: T
authors: Takahashi
mesh_terms: D001763:Blepharoptosis / Q000209:etiology*; D020520:Brain Infarction / Q000150:complications* / Q000473:pathology*; D007839:Functional Laterality; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008636:Mesencephalon / Q000473:pathology*; D008875:Middle Aged
keywords: Midbrain infarction; isolated unilateral ptosis; levator palpebrae superioris muscles; oculomotor fascicles