Monday, May 17, 2010

Approach patient with unilateral ptosis

When You see patient with partial ptosis, One of the commonest patient found in neuro station. See whether it is unilateral or bilateral.
for unilateral
The second thing to do is look directly to pupil size,
If pupil size is small then you should enter Horner syndrome protocol which i will explain in my next explaination.
If pupil size is big then , it is third nerve palsy(a surgical third nerve palsy) most likely posterior communicating artery aneurysm.
If pupil size is normal then most likely (medical third nerve palsy) most likely diabetic or vasculitis cause and etc.
Third please demonstate the eye movement to see whether got other nerve involvement.etc 4th or 5th
If got 3rd ,4th and 5th, consider Graves disease(lid retraction )
cavernous sinus 3th 4th 6th and 5th may coexixst(demonstrate corneal reflex)
tolosa hunt (pain with no redness)

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