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Suggest Tests To Reveal The Cause For Ptosis Of Eye Post Concussion
Question: My wife was in a car accident, she was rear ended and has suffered a severe concussion, and whiplash, shoulder tear and ptosis of her left eye. She had an MRI done yesterday on her eye and head to understand the cause of the Ptosis unfortunately it did not show anything. What tests can be done now to understand the cause of her ptosis, what else could cause it
Brief Answer:
Probably disinsertion of the levator palpebrae muscle by trauma.
Detailed Answer:
I read your question carefully and I understand your concern.
First of all, at seeing you use the word unfortunately for the negative MRI, I should say that instead you should be happy that it hasn't revealed any damage. That means that there is no brain involvement which could be threatening.
I am assuming that the ptosis is a unique finding, meaning with normal findings in regard to her visual acuity, visual field, facial nerve or other cranial nerves. If not please tell me.
At this point considering the post-trauma appearance and normal MRI, the most probable causes would be:
- traumatic injury to oculomotor nerve. It would be accompanied by other signs such as limitation of the range of movement of the eyeball and widening of the pupil compared to the other side.
- a Horner syndrome due to traumatic injury of the sympathetic nerve system which also supplies a muscle (Muller's muscle) which helps in elevating the eyelid. It is accompanied on the contrary to oculomotor nerve injury by constriction of the pupil.
- disinsertion of the levator palpebrae muscle (muscle which elevates eyelid) due to trauma. If the abovementioned pupil and eye movement signs are not present this would be the most probable cause. When due to injury they might recover by themselves in time, if not a simple surgical procedure may be used.
I remain at your disposal for further questions.
Probably disinsertion of the levator palpebrae muscle by trauma.
Detailed Answer:
I read your question carefully and I understand your concern.
First of all, at seeing you use the word unfortunately for the negative MRI, I should say that instead you should be happy that it hasn't revealed any damage. That means that there is no brain involvement which could be threatening.
I am assuming that the ptosis is a unique finding, meaning with normal findings in regard to her visual acuity, visual field, facial nerve or other cranial nerves. If not please tell me.
At this point considering the post-trauma appearance and normal MRI, the most probable causes would be:
- traumatic injury to oculomotor nerve. It would be accompanied by other signs such as limitation of the range of movement of the eyeball and widening of the pupil compared to the other side.
- a Horner syndrome due to traumatic injury of the sympathetic nerve system which also supplies a muscle (Muller's muscle) which helps in elevating the eyelid. It is accompanied on the contrary to oculomotor nerve injury by constriction of the pupil.
- disinsertion of the levator palpebrae muscle (muscle which elevates eyelid) due to trauma. If the abovementioned pupil and eye movement signs are not present this would be the most probable cause. When due to injury they might recover by themselves in time, if not a simple surgical procedure may be used.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Does that mean the levator muscle issue would not show on the MRI? She is not scheduled to see the neurologist until July.
Brief Answer:
Yes would not show.
Detailed Answer:
Yes, I listed those causes since they could not show changes on MRI, levator muscle issue as well. If that is the cause it doesn't represent any emergency, actually if it doesn't recover by itself the neurologist can't do much about it, only check for accompanying signs indicating other causes.
Of course the above listed causes are in case the ptosis appeared after the trauma, in case it was present before there are other neurological conditions to be considered by the neurologist.
If there is pupil constriction indicating Horner, I must precise that the MRI should include the neck to check for carotid artery dissection causing the Horner syndrome.
I hope to have been of help.
Yes would not show.
Detailed Answer:
Yes, I listed those causes since they could not show changes on MRI, levator muscle issue as well. If that is the cause it doesn't represent any emergency, actually if it doesn't recover by itself the neurologist can't do much about it, only check for accompanying signs indicating other causes.
Of course the above listed causes are in case the ptosis appeared after the trauma, in case it was present before there are other neurological conditions to be considered by the neurologist.
If there is pupil constriction indicating Horner, I must precise that the MRI should include the neck to check for carotid artery dissection causing the Horner syndrome.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
If it is the muscle how long does it usually take to come back and if it doesnt, who fixes it and how? Is there any other tests that can be done to confirm
Brief Answer:
Read below.
Detailed Answer:
If that is the cause recovery times are not an exact science and as I said surgery might be necessary, if there is improvement it usually takes place during the first 6 weeks.
There are no specific tests for that particular cause, it is a clinical diagnosis, tests are done when in doubt to differentiate it from other potential causes.
Read below.
Detailed Answer:
If that is the cause recovery times are not an exact science and as I said surgery might be necessary, if there is improvement it usually takes place during the first 6 weeks.
There are no specific tests for that particular cause, it is a clinical diagnosis, tests are done when in doubt to differentiate it from other potential causes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Who would make that clinical diagnosis ( a neurologist) and who would do the surgery if required
Brief Answer:
Ophthalmologist.
Detailed Answer:
Both a neurologist and an ophthalmologist can evaluate ptosis.
Generally when there is no indication as to the cause yet, a neurologist would be more appropriate, but in this case since most neurological possibilities have been excluded by the normal MRI and the fact of trauma being the cause, I would say an ophthalmologist is more appropriate.
He would also be the one to perform the surgery if that is confirmed as the cause.
I hope things work out for the best.
Ophthalmologist.
Detailed Answer:
Both a neurologist and an ophthalmologist can evaluate ptosis.
Generally when there is no indication as to the cause yet, a neurologist would be more appropriate, but in this case since most neurological possibilities have been excluded by the normal MRI and the fact of trauma being the cause, I would say an ophthalmologist is more appropriate.
He would also be the one to perform the surgery if that is confirmed as the cause.
I hope things work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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