Ptose palpebral bilateral com paralisia unilateral do olhar vertical para cima: registro de caso

Brasil Neto, Joaquim Pereira; Tosta, Elza Dias; Henriques, Fernando Guilhon

doi:10.1590/S0004-282X1986000100012

Resumos

Os autores descrevem um caso de ptose palpebral bilateral com paralisia do olhar vertical para cima, predominantemente unilateral, após acidente vascular hemorrágico do tronco encefálico. Outra característica marcante do quadro clínico foi um estado de sonolência que regrediu lentamente. Após revisão da literatura sobre a fisiopatologia da ptose palpebral e dos movimentos oculares verticais, juntamente com a análise de casos publicados, são propostas explicações para os aspectos clínicos peculiares do presente caso, sempre relacionadas ao resultado da tomografia computadorizada.

The authors report a case of bilateral ptosis with miosis, paralysis of upward gaze and of smooth pursuit movements to the right, as well as a slowly regressive state of lassitude. This syndrome followed a haemorragic brain stem infarction. After a review of the pathophysiology of ptosis and of vertical eye movements, together with analysis of data provided by computerized tomography studies - since the case was not fatal - explanations are offered for each clinical sign and it is proposed that the lesion, a paramedian, slightly deviated to the right haemorragic focus in the midbrain, with a diameter of 15mm, might have involved several structures, namely the rostral interstitial nucleus of the medial longitudinal fasciculus, the mesencephalic reticular formation, as well as cortico-nuclear and sympathetic pathways.

Joaquim Pereira Brasil Neto^I; Elza Dias Tosta^II; Fernando Guilhon Henriques^III

^IMédico Residente, Unidade de Neurologia, Hospital de Base da FHDF, Brasília

^IINeurologista, Fundação Hospitalar do DF, Brasília

^IIINeurologista, Professor da Universidade de Brasília

RESUMO

Os autores descrevem um caso de ptose palpebral bilateral com paralisia do olhar vertical para cima, predominantemente unilateral, após acidente vascular hemorrágico do tronco encefálico. Outra característica marcante do quadro clínico foi um estado de sonolência que regrediu lentamente. Após revisão da literatura sobre a fisiopatologia da ptose palpebral e dos movimentos oculares verticais, juntamente com a análise de casos publicados, são propostas explicações para os aspectos clínicos peculiares do presente caso, sempre relacionadas ao resultado da tomografia computadorizada.

SUMMARY

The authors report a case of bilateral ptosis with miosis, paralysis of upward gaze and of smooth pursuit movements to the right, as well as a slowly regressive state of lassitude. This syndrome followed a haemorragic brain stem infarction. After a review of the pathophysiology of ptosis and of vertical eye movements, together with analysis of data provided by computerized tomography studies - since the case was not fatal - explanations are offered for each clinical sign and it is proposed that the lesion, a paramedian, slightly deviated to the right haemorragic focus in the midbrain, with a diameter of 15mm, might have involved several structures, namely the rostral interstitial nucleus of the medial longitudinal fasciculus, the mesencephalic reticular formation, as well as cortico-nuclear and sympathetic pathways.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Agradecimentos - Os autores agradecem a valiosa colaboração, na elaboração das ilustrações, dos Srs. José Artur de Vasconcelos Grossi (desenhista) e Antônio Garcia Filho (Fotógrafo"), bem como dos demais membros da equipe do Centro de Recursos Audio-Visuais da FHDF-CERAV.

Unidade de Neurologia do Hospital de Base do DF, Fundação Hospitalar do DF - 70335 - Brasília. DF - Brasil.

1. BILLER, J.; SHAPIRO, R.; EVANS, L.S.; HAAG, J.R. & FINE, M. - Oculomotor nuclear complex infarction. Arch. Neurol. 41: 985, 1984.
2. BUTTNER-ENNEVER, J.A.; BttTTNER, V.; COHEN, B. & BAUMGARTNER, G. - Vertical gaze paralysis and the rostral intersticial nucleus of the medial longitudinal fasciculus. Brain 105: 125, 1982.
3. CAP LAN, L.R. - Ptosis. J. Neurol. Neurosurg. Psychiat. 37: 1, 1974.
4. FISHER, CM. - Some neuro-ophtalmological observations. J. Neurol. Neurosurg. Psychiat. 30 : 366, 1967.
5. GROWDON, J.H.; WINKLER, G.F. & WRAY, S.H. - Midbrain ptosis. Arch. Neurol. 30: 179, 1974.
6. JAMPEL, R.S. & FELLS, P. - Monocular elevation paresis caused by a central nervous system lesion. Arch. Ophtalm. 80 : 45, 1968.
7. LESSEL, S. - Supranuclear paralysis of monocular elevation. Neurology 25: 1134, 1975.
8. NASHOLD, JR., B.S.: GILLS, JR., J.P. & DURHAM, N.L. - Ocular signs from brain stimulation and lesions. Arch. Ophtalm. 77 : 609, 1967.
9. SEGARRA, J.M. - Cerebral vascular disease and behaviour. I. The syndrome of the mesencephalic artery. Arch. Neurol. 22 : 408, 1979.
10. WARWICK, R. - Representation of the extraocular muscles in the oculomotor nuclei of the monkey. J. como. Neurol. 98 : 449, 1953.
11. ZACKON, D.H. & SHARPE, J.A. - Midbrain Paresis of the Horizontal gaze. Ann. Neurol., vol. 16, n 14, oct. 1984, 495.

Ptose palpebral bilateral com paralisia unilateral do olhar vertical para cima: registro de caso

Bilateral palpebral ptosis and unilateral paralysis of upward gaze: a case report

Datas de Publicação

Publicação nesta coleção
29 Jun 2011
Data do Fascículo
Mar 1986

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BILLER, J.; SHAPIRO, R.; EVANS, L.S.; HAAG, J.R. & FINE, M. - Oculomotor nuclear complex infarction. Arch. Neurol. 41: 985, 1984.

[2] 2. BUTTNER-ENNEVER, J.A.; BttTTNER, V.; COHEN, B. & BAUMGARTNER, G. - Vertical gaze paralysis and the rostral intersticial nucleus of the medial longitudinal fasciculus. Brain 105: 125, 1982.

[3] 3. CAP LAN, L.R. - Ptosis. J. Neurol. Neurosurg. Psychiat. 37: 1, 1974.

[4] 4. FISHER, CM. - Some neuro-ophtalmological observations. J. Neurol. Neurosurg. Psychiat. 30 : 366, 1967.

[5] 5. GROWDON, J.H.; WINKLER, G.F. & WRAY, S.H. - Midbrain ptosis. Arch. Neurol. 30: 179, 1974.

[6] 6. JAMPEL, R.S. & FELLS, P. - Monocular elevation paresis caused by a central nervous system lesion. Arch. Ophtalm. 80 : 45, 1968.

[7] 7. LESSEL, S. - Supranuclear paralysis of monocular elevation. Neurology 25: 1134, 1975.

[8] 8. NASHOLD, JR., B.S.: GILLS, JR., J.P. & DURHAM, N.L. - Ocular signs from brain stimulation and lesions. Arch. Ophtalm. 77 : 609, 1967.

[9] 9. SEGARRA, J.M. - Cerebral vascular disease and behaviour. I. The syndrome of the mesencephalic artery. Arch. Neurol. 22 : 408, 1979.

[10] 10. WARWICK, R. - Representation of the extraocular muscles in the oculomotor nuclei of the monkey. J. como. Neurol. 98 : 449, 1953.

[11] 11. ZACKON, D.H. & SHARPE, J.A. - Midbrain Paresis of the Horizontal gaze. Ann. Neurol., vol. 16, n 14, oct. 1984, 495.