Chronic hydrocephalus presenting with bilateral ptosis after minor head injury: Case report

OBJECTIVE AND IMPORTANCE: Some patients with hydrocephalus may exhibit vari ous signs of oculomotor dysfunction. However, ptosis has not previously bee n described in chronic hydrocephalus patients. CLINICAL PRESENTATION: We report a 50-year-old woman who was diagnosed with chronic hydrocephalus based on an evaluation for bilateral ptosis after a minor head injury. She exhibited bilateral ptosis and upward gaze paralysis , but other oculomotor functions were normal. Neuroimages revealed chronic hydrocephalus with no traumatic abnormalities. INTERVENTION: The eyelid dysfunction resolved after placement of a right ve ntriculoperitoneal shunt with a programmable pressure valve. CONCLUSION: The resolution of eyelid dysfunction by cerebrospinal fluid div ersion suggests that chronic hydrocephalus was involved in the development of ptosis after the minor head injury. A mild but sudden cerebrospinal flui d pressure change at the time of minor head injury might induce functional impairment at the level of vulnerable periaqueductal structures, which bare ly withstood the longstanding ventriculomegaly, resulting in the clinical f eatures observed in our patient.