Platysma-Levator Synkinesis in Congenital Third Nerve Palsy

Abstract

Congenital third nerve palsy is an uncommon condition that may result from perinatal trauma to the peripheral oculomotor nerve or from brainstem injury in utero. 1 Several reports have documented oculomotor synkinesis in this condition, which may produce elevation of the ptotic eyelid on attempted depression or adduction of the affected eye. 1 We describe a patient with an unusual congenital third nerve palsy who had episodic upper-eyelid elevation caused by a platysma-levator synkinesis. Report of a Case. —A 4-year-old girl was referred for evaluation of a right congenital third nerve palsy. Although there was no history of birth trauma or forceps delivery, she had a birthmark on the right side of her forehead until age 1 year. A previous neurologic examination disclosed no other abnormalities. Results of a high-resolution magnetic resonance scan of the head and orbits with gadolinium enhancement were normal. Corrected visual acuity was 20/100 OD and