Neurological Presentations

Question 1

What is the term for drooping of the eyelid?

Answer 1

Ptosis

Question 2

What is lid lag?

Answer 2

Delay in moving eyelid down as the eye moves downwards.

Question 3

How might a ptosis present?

Answer 3

Pt comes in complaining of change in appearance so they always look sleepy or tired, or have restricted visual fields.

Question 4

What systemic response can mimic ptosis?

Answer 4

Allergic reaction causing eyelid oedema

Question 5

If a patient with a history of cancer presented with new onset ptosis, what might you begin to suspect?

Answer 5

New orbital tumour or metastatic cancer (intracranial)

Question 6

On exmination of a patient wth ptosis, what should you look for?

Answer 6

Appearance - is there ptosis? To what degree? Is there concurrent cranial nerve palsies affecting the eye? Lower lid laxity? Bulging of the globe? Eyelid retraction? Changes to skin around the eye? Swelling or signs of infection?

Question 7

In which patients is lid lag a common finding?

Answer 7

Patients with thyroid eye disease.

Question 8

A patient complains of ptosis that seems to fluctuate, and some other neurological symptoms including muscle fatigue after exercise. What is your top differential?

Answer 8

Myasthenia gravis