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The Eye Opener: Finding and Targeting the Midbrain Lesion

Aditya Choudhary1, Rajveer Singh1, Manoj Goyal1

  • 1Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Neuro-Ophthalmology (Aeolus Press)
|December 5, 2018
PubMed

Insights

Bilateral ptosis can result from lesions affecting the third cranial nerve's central nucleus in the midbrain. This case highlights how midbrain lesions involving bilateral innervation can cause non-correctable ptosis and medial rectus palsy.

Area of Science:

  • Neuroscience
  • Ophthalmology
  • Neurology

Background:

  • Lesions in the midbrain affecting the central nucleus of the third cranial nerve can cause bilateral ptosis.
  • The third cranial nerve controls eyelid elevation and eye movements.

Purpose of the Study:

  • To present a case study of a pediatric patient with bilateral ptosis and medial rectus palsy.
  • To illustrate the neuroanatomical basis of bilateral ptosis resulting from central midbrain lesions.

Main Methods:

  • Case report of a 14-year-old male.
  • Clinical examination including assessment of ptosis and extraocular muscle function.
  • Contrast-enhanced Magnetic Resonance Imaging (MRI) of the brain to identify lesions.

Main Results:

  • The patient presented with bilateral, non-correctable ptosis and medial rectus palsy.
  • A ring-enhancing lesion was identified in the midbrain on MRI.
  • The lesion showed resolution following treatment.

Conclusions:

  • Bilateral ptosis can arise from involvement of the third cranial nerve's central nucleus due to its bilateral innervation.
  • Midbrain lesions, even when focal, can manifest with significant ophthalmoplegia.
  • Prompt diagnosis and treatment of underlying causes are crucial for managing such neurological deficits.
Keywords:
Neurocysticercosisbilateral ptosiscentral oculomotor nucleus

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