AME case reports · 2025
The role of cerebral ptosis in assessing recovery and prognosis in traumatic brain injury: a case report.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Di Lorenzo Luigi, Iapaolo David, Pirraglia Nicola, Lozada Daniel Araujo, Di Palma Matilde, D'Avanzo Carmine
Аннотация
BACKGROUND: Cerebral ptosis is a rare and often under-recognized condition characterized by eyelid drooping due to central nervous system dysfunction, rather than peripheral neuromuscular damage. While typically associated with strokes, tumors, or brainstem lesions, its presence in traumatic brain injury (TBI) remains poorly documented. The clinical implications of cerebral ptosis in neurorehabilitation are underexplored, especially regarding its potential role as a marker of neurological recovery. In particular, transitions in ptosis patterns-such as from bilateral to unilateral-may reflect underlying neural reorganization. This case report aims to highlight the prognostic and rehabilitative relevance of cerebral ptosis in a patient with severe TBI.
CASE DESCRIPTION: We present the case of a 46-year-old man admitted to a neurorehabilitation unit after sustaining a severe TBI with left-sided epidural hematoma and bilateral mydriasis. Following emergency neurosurgery and prolonged coma, the patient exhibited bilateral cerebral ptosis, minimal responsiveness, and severe cortical dysfunction. Imaging revealed bilateral structural damage including the left temporal and occipito-parietal lobes and the right cerebral peduncle. Over the course of neurorehabilitation, clinical and electrophysiological evaluations documented progressive neurological recovery, coinciding with a shift from bilateral to unilateral ptosis, restoration of right eyelid control, emergence of blink commands, and transition from vegetative state to minimally conscious state.
CONCLUSIONS: This case suggests that cerebral ptosis-particularly its transition from bilateral to unilateral-can serve as a dynamic and clinically useful marker of neurological recovery in TBI patients. Careful monitoring of ptosis patterns, in conjunction with neuroimaging and functional assessments, may enhance early detection of consciousness recovery and guide individualized rehabilitation strategies.
CASE DESCRIPTION: We present the case of a 46-year-old man admitted to a neurorehabilitation unit after sustaining a severe TBI with left-sided epidural hematoma and bilateral mydriasis. Following emergency neurosurgery and prolonged coma, the patient exhibited bilateral cerebral ptosis, minimal responsiveness, and severe cortical dysfunction. Imaging revealed bilateral structural damage including the left temporal and occipito-parietal lobes and the right cerebral peduncle. Over the course of neurorehabilitation, clinical and electrophysiological evaluations documented progressive neurological recovery, coinciding with a shift from bilateral to unilateral ptosis, restoration of right eyelid control, emergence of blink commands, and transition from vegetative state to minimally conscious state.
CONCLUSIONS: This case suggests that cerebral ptosis-particularly its transition from bilateral to unilateral-can serve as a dynamic and clinically useful marker of neurological recovery in TBI patients. Careful monitoring of ptosis patterns, in conjunction with neuroimaging and functional assessments, may enhance early detection of consciousness recovery and guide individualized rehabilitation strategies.