A 48-year-old man with ptosis and limitation of elevation in the left eye

© 2014 American Academy of Neurology

Teaching NeuroImagesNeurology

Resident and Fellow Section

Vignette

• A 48-year-old man presented with ptosis in the left eye for 2 months.

• He denied ocular pain, diplopia, visual loss, or diurnal fluctua-tion.

• Neurologic examination showed incomplete ptosis and limita-tion of elevation with normal pupil in the left eye.

Park et al.© 2014 American Academy of Neurology

Imaging

© 2014 American Academy of Neurology Park et al.

• Divisional patterns of oculomotor nerve palsy usually indicate a lesion involving the oculomotor nerve distal to anterior cav-ernous sinus where the nerve divides into the superior and in-ferior branches.

• In this patient, the ptosis and limitation of elevation in the left eye indicate a lesion limited to the oculomotor superior divi-sion that innervates the levator palpebrae and superior rec-tus.

• Orbital lesions including lymphoma should be considered in divisional patterns of oculomotor palsy.

Superior Divisional Oculomotor Nerve Palsy due to Orbital Lymphoma

© 2014 American Academy of Neurology Park et al.