Bilateral ptosis in multiple sclerosis - Case reports and survey

Multiple sclerosis patients with isolated cranial nerve symptoms often pres ent topodiagnostic and differential diagnostic problems. We report on two c ases who developed a bilateral ptosis. A central bilateral ptosis might be mitigated through a single lesion in the region of the pontomesencephal cen tral nucleus which innervates the levator palpebrae muscles. If a bilateral ptosis is evident a careful examination of vertical eye movements as well as lid-eye coordination is necessary on the background of the close topogra phic relationship of mesencephalic vertical gaze areas with the central nuc leus. If there is neither clinically nor paraclinically further proof for a pontomesencephalic process further differential diagnostics should be omit ted. Especially mitochondrial diseases can be ruled out because of the repo rted association of multiple sclerosis and mitochondriopathies.