Sunday, April 30, 2006

Ptosis for PACES

Ptosis is often missed by PACES candidates. The sign is subtle especially if it is a partial ptosis. In PACES, ptosis carries a lot of weight in reaching the correct diagnosis in neurology station.
The common scenario would be: Please examine the patient's eyes.

1. Look at the level of the eyelid, look for asymmetry
  • Unilateral/bilateral
  • Partial/complete

2. Then, proceed to check the pupil, look for anisocoria (unequal pupil)

  • dilated in 3rd nerve palsy
  • constricted in Horner's syndrome
  • normal size pupil in MG, CPEO, dystrophy myotonica

3. Look for eye position, any strabismus

  • looking downward and outward in 3rd nerve palsy
  • variable strabismus in MG


Right 3CN palsy

Left Horner's syndrome

Myasthenia Gravis with bilateral partial ptosis


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2 comments:

  1. Axonopathic5/01/2006 01:37:00 AM

    Thanks eMRCPian for the ptosis tips. Just want to share. I had a short case earlier on:

    50y/o lady, bilateral partial ptosis, normal pupils and normal EOM, wasting of the temporalis and frontal balding. But couldn't elicit myotonia clinically.

    I thought of dystrophia myotonica straightaway. Differential being MG but less likely.

    Verdict:
    Fascioscapulohumeral Muscular Dystrophy

    Tips: Must check upper limbs and lower limbs and look particularly for winging of scapula

    ReplyDelete
  2. Dr. David Teoh5/02/2006 12:26:00 AM

    more discussion in Ptosis (2)

    ReplyDelete