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Sudden asymmetric bilateral ptosis as stroke onset
  1. Roberto López-Blanco1,
  2. Yerko Ivánovic-Barbeito1,
  3. Alberto Villarejo-Galende1,
  4. Carmen Sánchez-Sánchez1,
  5. Jaime Díaz-Guzmán1,2
  1. 1Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
  2. 2Stroke Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
  1. Correspondence to Roberto López-Blanco, Avenida de Córdoba s/n, Hospital Universitario 12 de Octubre, Madrid 28041, Spain; robretolb{at}gmail.com

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A 56-year-old woman presented to the emergency department with sudden onset of left-sided ptosis, perioral paraesthesias and dizziness, without imbalance or vertigo, after getting up from bed. She had hyperlipidaemia and was a smoker. General examination was normal. On neurological examination there was asymmetric bilateral ptosis, more on the left, without pupillary or eye movement abnormalities (figure 1). Other cranial nerves, motor and sensory examination, coordination, posture and gait were unremarkable. The Cogan lid-twitch test and eyelid ice-pack test were normal.

Figure 1

Asymmetric bilateral ptosis. Note the left eyelid is lower than the …

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