Intact Bell's Phenomenon in a Patient With Myasthenia Gravis and Upward Gaze Paresis

Abstract

To the Editor. —Bell's phenomenon is one of several physiologic facial-ocular synkineses. It usually consists of outward and upward rolling of the eyes when forcible efforts are made to close the eyes against resistance. 1(p965) The presence of this movement in patients who cannot voluntarily elevate the eyes indicates that brain-stem pathways between the facial nerve nucleus and that portion of the oculomotor nerve nucleus responsible for elevation of the eyes are intact. 2 Such patients are said to have supranuclear paralysis of upward gaze. We recently examined a 32-year-old woman who developed bilateral ptosis and ophthalmoparesis over the course of several weeks. When she was examined initially, the patient had almost complete bilateral ptosis and ophthalmoparesis. She could not voluntarily elevate either eye above midline, and oculocephalic testing (doll's head maneuver) failed to improve eye movement in any direction. However, she had an intact Bell's phenomenon in the right