Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 68 year old woman with transient ptosis on awakening.

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Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 68 year old woman with transient ptosis on awakening

Della Marca et al. VIGNETTE Unilateral, complete, right ptosis on awakening The disturbance started at age 66 Ptosis occurred after every awakening, from nocturnal sleep and daytime naps Ptosis lasted 4-5 minutes Neurological examination was normal (in particular, no cranial nerve palsy) Brain MRI and EMG were unremarkable

Della Marca et al. Fig 1 Fig 2 IMAGING

Della Marca et al. Awakening ptosis (unilateral hypnopompic eyelid palsy) Ptosis occurred after awakening from deep NREM & REM sleep stages. Brain MRI, EMG, & polysomnography were otherwise unremarkable. Awakening ptosis has been described as “benign unilateral apraxia of eyelid opening” 1. is a benign phenomenon, not associated with any neurological disease, but the differential diagnosis includes myesthenia gravis & other neuromuscular disorders 2. may be due to an abnormal, transient persistence of sleep- related eyelid atonia.