Collier's sign

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Collier's sign
Differential diagnosis Midbrain lesion

Collier's sign (also known as Collier's tucked lid sign [1] or posterior fossa stare [2] ) is bilateral or unilateral eyelid retraction.

Eyelid thin fold of skin that covers and protects the human eye

An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyelid features a row of eyelashes along the eyelid margin, which serve to heighten the protection of the eye from dust and foreign debris, as well as from perspiration. "Palpebral" means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies.

It is an accepted medical sign of a midbrain lesion, first described in 1927 by J Collier. [3] With the eyes in the primary position, the sclera can be seen above the cornea, and further upgaze increases the distance between the eyelids and irises. [4] Causes include upper dorsal midbrain supranuclear lesions such as Parinaud's syndrome, 'top of the basilar syndrome', [2] midbrain infarction, neurodegeneration or tumour, multiple sclerosis, encephalitis, and Miller-Fisher syndrome. [5] The cause is thought to be damage to the posterior commissure levator inhibitory fibres [2] which originate in the M-group of neurons. [4]

Midbrain

The midbrain or mesencephalon is a portion of the central nervous system associated with vision, hearing, motor control, sleep/wake, arousal (alertness), and temperature regulation.

Sclera

The sclera, also known as the white of the eye, is the opaque, fibrous, protective, outer layer of the human eye containing mainly collagen and some elastic fiber. In humans, the whole sclera is white, contrasting with the coloured iris, but in other mammals the visible part of the sclera matches the colour of the iris, so the white part does not normally show. In the development of the embryo, the sclera is derived from the neural crest. In children, it is thinner and shows some of the underlying pigment, appearing slightly blue. In the elderly, fatty deposits on the sclera can make it appear slightly yellow. Many people with dark skin have naturally darkened sclerae, the result of melanin pigmentation.

Cornea part of the eye

The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. The cornea, with the anterior chamber and lens, refracts light, with the cornea accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is approximately 43 dioptres. The cornea can be reshaped by surgical procedures such as LASIK.

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Spinothalamic tract

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Argyll Robertson pupils are bilateral small pupils that reduce in size on a near object, but do not constrict when exposed to bright light. They are a highly specific sign of neurosyphilis; however, Argyll Robertson pupils may also be a sign of diabetic neuropathy. In general, pupils that accommodate but do not react are said to show light-near dissociation (i.e., it is the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus.

Diencephalon consists of structures that are lateral to the third ventricle, and includes the thalamus, the hypothalamus, the epithalamus and the subthalamus; one of the main vesicles of the brain formed during embryogenesis

The diencephalon is a division of the forebrain, and is situated between the telencephalon and the midbrain. It consists of structures that are on either side of the third ventricle, including the thalamus, the hypothalamus, the epithalamus and the subthalamus.

Blepharitis eyelid disease that is characterized by often chronic inflammation of the eyelid, generally the part where eyelashes grow

Blepharitis is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The overall etiology is a result of bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

Progressive supranuclear palsy (PSP), also known as Steele–Richardson–Olszewski syndrome, is a degenerative disease involving the gradual deterioration and death of specific volumes of the brain. The condition leads to symptoms including loss of balance, slowing of movement, difficulty moving the eyes, and dementia. PSP may be mistaken for other neurodegenerative diseases such as Parkinson's and Alzheimer's. The cause of the condition is uncertain, but involves accumulation of tau protein within the brain. Medications such as levodopa and amantadine may be useful in some cases.

Posterior cerebral artery

The posterior cerebral artery (PCA) is one of a pair of arteries that supply oxygenated blood to the occipital lobe, part of the back of the human brain. It begins near where the posterior communicating artery and the basilar artery join, and connects with the middle cerebral artery of the same side and internal carotid artery via the posterior communicating artery.

Parinauds syndrome

Parinaud's syndrome, is an inability to move the eyes up and down. It is caused by compression of the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF). The eyes lose the ability to move upward and down.

Pinealoma endocrine gland located in the pineal gland located in the brain

A pinealoma is a tumor of the pineal gland, a part of the brain that produces melatonin. If a pinealoma destroys the cells of the pineal gland in a child, it can cause precocious puberty.

Superior cerebellar peduncle

In the human brain, the superior cerebellar peduncle is a paired structure of white matter that connects the cerebellum to the midbrain. It consists mainly of efferent fibers, the cerebellothalamic tract that runs from a cerebellar hemisphere to the contralateral thalamus, and the cerebellorubral tract that runs from a cerebellar hemisphere to the red nucleus. It also contains afferent tracts, most prominent of which is the ventral spinocerebellar tract. Other afferent tracts are the trigeminothalamic fibers, tectocerebellar fibers, and noradrenergic fibers from the locus coeruleus. The superior peduncle emerges from the upper and medial parts of the white matter of each hemisphere and is placed under cover of the upper part of the cerebellum.

Ptosis (eyelid) eye disease characterized by the drooping or falling of the upper or lower eyelid

Ptosis is a drooping or falling of the upper eyelid. The drooping may be worse after being awake longer when the individual's muscles are tired. This condition is sometimes called "lazy eye," but that term normally refers to the condition amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.

Henri Parinaud French ophthalmologist

Henri Parinaud was a French ophthalmologist and neurologist, most noted for his work in the field of neuro-ophthalmology.

Webers syndrome neurovascular disease

Weber's syndrome, also known as superior alternating hemiplegia, is a form of stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. It is caused by midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery or of basilar bifurcation perforating arteries.

Conjugate gaze palsies are neurological disorders affecting the ability to move both eyes in the same direction. These palsies can affect gaze in a horizontal, upward, or downward direction. These entities overlap with ophthalmoparesis and ophthalmoplegia.

Posterior cerebral artery syndrome Human disease

Posterior cerebral artery syndrome is a condition whereby the blood supply from the posterior cerebral artery (PCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the occipital lobe, the inferomedial temporal lobe, a large portion of the thalamus, and the upper brainstem and midbrain.

Benedikt syndrome, also called Benedikt's syndrome or paramedian midbrain syndrome, is a rare type of posterior circulation stroke of the brain, with a range of neurological symptoms affecting the midbrain, cerebellum and other related structures.

Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is Greek for the word "madao" which means "to fall off." It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.

Claude's syndrome is a form of brainstem stroke syndrome characterized by the presence of an ipsilateral oculomotor nerve palsy, contralateral hemiparesis, contralateral ataxia, and contralateral hemiplegia of the lower face, tongue, and shoulder. Claude's syndrome affects oculomotor nerve, red nucleus and brachium conjunctivum

The hypothalamospinal tract connects the hypothalamus to the ciliospinal center of the intermediolateral cell column in the spinal cord. It is found in the dorsolateral quadrant of the lateral funiculus, in the lateral tegmentum of the medulla, pons and midbrain. Lesions of the hypothalamospinal tract cause ipsilateral Horner's syndrome.

In ophthalmology, apraxia of lid opening (ALO) is an inability to initiate voluntary opening of the eyelid following a period of eyelid closure, with normal function at other times. Manual lifting of the eyelid often resolves the problem and the lid is able to stay open.

James Stansfield Collier (1870–1935) was an English physician and neurologist.

References

  1. "Colliers sign". biology-online.org.
  2. 1 2 3 Larner, Andrew J. (2010). A Dictionary of Neurological Signs. Springer Publishing.(subscription required)
  3. J. Collier, Nuclear Ophthalmoplegia with special reference to retraction of the lids and ptosis and to lesions of the posterior commissure. Brain (journal) 1927; 50; 488 - 498.
  4. 1 2 Wray. "Supranuclear Paralysis of Upgaze".
  5. Miyashi M et al., Rinsho Shinkeigaku. 2006 Oct;46(10):712-4