From the Guidelines
Ptosis from brainstem compression of a mass should not be considered a craniopathy, as it is a neurological disorder resulting from pressure on cranial nerve III or its nucleus in the brainstem, rather than a structural issue of the skull itself. A craniopathy is a disorder or abnormality affecting the cranium (skull) and its associated structures, which can include the bones, sutures, and related tissues. It typically refers to structural issues of the skull itself rather than functional problems of the brain within. The distinction is important because craniopathies primarily involve the skull structure, while ptosis from brainstem compression represents a functional neurological deficit caused by pressure on neural tissue, as seen in cases of vestibular schwannoma where brainstem compression or hydrocephalus could be symptoms of large tumors 1.
Key Points
- Craniopathies involve structural issues of the skull, such as abnormalities in the bones, sutures, or related tissues.
- Ptosis from brainstem compression is a neurological disorder, not a craniopathy, as it results from pressure on cranial nerve III or its nucleus in the brainstem.
- Treatment for ptosis from brainstem compression targets the underlying mass, such as tumors or aneurysms, rather than addressing a skull abnormality, which would be the focus in true craniopathies.
- Clinical signs of deterioration in swollen supratentorial hemispheric ischemic stroke include new or further impairment of consciousness, cerebral ptosis, and changes in pupillary size, highlighting the importance of distinguishing between craniopathies and neurological disorders 1.
Implications for Treatment
The underlying mass causing the compression could be various pathologies, including tumors, aneurysms, or other space-occupying lesions. Treatment would target the underlying mass rather than addressing a skull abnormality, further distinguishing it from true craniopathies which might require craniofacial surgical approaches or other interventions directed at the skull structure itself. Patient management should be based on the severity of the ocular findings and ranges from symptomatic treatment like moistening eye drops to surgical reanimation of the facial nerve via hypoglossal facial nerve anastomosis and symptomatic plastic measure for the eye or face, as recommended for patients with facial nerve palsy 1.
From the Research
Definition of Craniopathy
- Craniopathy is not explicitly defined in the provided studies, but based on the context, it can be inferred that craniopathy refers to a condition or disorder affecting the cranium, which may include the brain, brainstem, and surrounding structures.
Ptosis from Brainstem Compression of a Mass
- Ptosis, or drooping of the upper eyelid, can be caused by various factors, including brainstem compression of a mass 2, 3, 4.
- Brainstem compression can lead to neurogenic ptosis, which is a type of ptosis caused by dysfunction of the nerves that control the eyelid muscles 3, 4.
- However, the provided studies do not specifically discuss whether ptosis from brainstem compression of a mass can be considered a craniopathy.
- Nevertheless, since craniopathy refers to a condition affecting the cranium, and brainstem compression of a mass is a condition that affects the cranium, it can be argued that ptosis from brainstem compression of a mass can be considered a type of craniopathy.
Types of Ptosis
- The provided studies discuss various types of ptosis, including:
- Aponeurotic ptosis: accounts for the majority of acquired ptosis encountered in clinical practice 3.
- Neurogenic ptosis: caused by dysfunction of the nerves that control the eyelid muscles 3, 4.
- Myogenic ptosis: caused by muscle weakness or dysfunction 2, 3.
- Cerebral ptosis: occurs in cases of cerebral ischemic or hemorrhagic stroke, trauma, or tumor without involvement of brainstem or oculo-sympathetic mechanism 5.