Objective:

To describe a rare presentation of unilateral ptosis secondary to a supratentorial cerebral infarct and emphasize the importance of differentiating cerebral ptosis from other causes of eyelid drooping.

Background:

Cerebral ptosis (CP) is a rare and often underrecognized manifestation of supratentorial lesions, most commonly ischemic strokes. It presents as eyelid drooping due to cerebral hemispheric involvement, with preserved pupils and extraocular movements, frequently leading to misdiagnosis as oculomotor or orbital pathology. Awareness of CP and its imaging correlates is essential for accurate localization and prompt stroke-directed management.

Design/Methods:

A 68-year-old male presented with acute-onset left ptosis and diplopia. Neurological and ophthalmological examinations were normal except for partial left eyelid drooping. MRI brain revealed an acute infarct in the right peritrigonal white matter, with no brainstem or oculomotor involvement. Stroke workup including CT angiography, echocardiography, and Holter monitoring was unremarkable. The patient was treated with dual antiplatelet therapy and standard post-stroke rehabilitation.

Results:

Comprehensive evaluation excluded orbital and brainstem involvement, confirming supranuclear ptosis due to an acute right peritrigonal infarct. The patient received dual antiplatelet therapy with rehabilitation and achieved full recovery within three weeks, with resolution of ptosis and diplopia.

Conclusions:

Cerebral ptosis can be a manifestation of supratentorial cerebral infarction. Early recognition and exclusion of orbital or brainstem causes are essential to direct appropriate stroke management. Thorough differential diagnosis enables timely treatment and favorable outcomes, as illustrated by complete recovery after dual antiplatelet therapy and rehabilitation.