Françoise Heran MD, Presenter: Nothing to Disclose

François LaFitte MD, Abstract Co-Author: Nothing to Disclose

Patricia Koskas-Boublil MD, Abstract Co-Author: Nothing to Disclose

Marc Williams, Abstract Co-Author: Nothing to Disclose

Olivier Berges MD, Abstract Co-Author: Nothing to Disclose

Jean Daniel Piekarski MD, Abstract Co-Author: Nothing to Disclose

Jerry Blustajn MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

This prospective studies of uni or bilateral ptosis (or falling lid) aims to define an imaging protocol according to the most probable etiology . Some causes need treatment in emergency and should not be missed.

During one year, we performed orbital (thin T2 and T1 fat suppressed gadolinium enhanced T1 sequences) and or brain (T1, T2 WI with thin coronal caverneous sinuses study) or cervical (fat-suppressed T1, Angio MR of the internal carotid) in patients with uni or bilateral ptosis . Among them, we selected 57 cases with pathological examination (34 females, 23 men, 3 to 75 year-old). Clinical data were collected and analyzed, then correlated to imaging findings and fianl diagnosis

Pathological MR were classified depending on MR aspect and location of the disease : Orbital lesion (15), cavernous sinus disease (9), lesion impairing the III rd cranial nerve (13), Horner’s syndrome (16, with among them 13 internal carotid dissections ), others causes : 4 Correlation with clinical data were made. Clinical examination provides mandatory clues for the choice of the MR imaging protocol : if the proptosis is painful and the pupilla abnormal, two vascular emergencies should be systematically ruled out or confirmed : internal carotid dissection if a myosis is disclosed, aneurysm compressing the III rd cranial nerve in case of mydiasis. Proptosis and exophtalmos needs orbital study, while ophtalmoplegia leads to cavernous sinus and extraocular muscles analysis.

Imaging protocol is mandatory to confirm or rule out vascular etiology such as aneurysm or internal carotid artery dissection, which need angio MR focused either on neck vessels or on intracranial arteries. Clinical orientation is helpful and should be systematically detailed. Other causes such as III rd cranial nerve lesion need precise study of the whole nerve, with thin slices, while exophtalmos orientates toward orbital lesion and ophtalmoplegia toward orbital or cavernous sinus disease.

Heran, F, LaFitte, F, Koskas-Boublil, P, Williams, M, Berges, O, Piekarski, J, Blustajn, J, et al, , Imaging of Ptosis: MR and Clinical Data Analysis in 57 Patients.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4419195.html