Abstract
The phenomena involved in paradoxical upper lid retraction have been observed during recovery from paralysis of the third cranial nerve (CN). One of these phenomena is pseudo-Graefe's sign or Fuch's sign [21], which is characterized by elevation or retraction of the upper eyelid when the eye is looking downwards and inwards. This synkinesis is caused by an aberrant regeneration of newly formed axons of the third CN that subsequently reach muscles not originally connected with them. Pseudo-Graefe's sign may occur after congenital or acquired deseases. Acquired forms occur more frequently and result from paralysis of the third CN following various intracranial diseases: aneurysms [8, 9, 12, 15, 19, 29], traumas [4, 6, 7, 9, 11, 14, 16, 18, 22, 23, 29], and tumors [1, 2, 5, 17, 25, 27–29].
Similar content being viewed by others
References
Asbury AK, Aldredge H, Hershberg R, Fisher CM (1970) Oculomotor palsy in diabetes mellitus: a clinicopathological study. Brain 93:555–566
Bender MB (1936) The nerve supply to orbicolaris muscle and the physiology. of movements of the upper lid: with particular reference to the Pseudo-Graefe phenomenon. Arch Ophthalmol 15:21–30
Bender MB, Fulton JF (1939) Factors in functional recovery following section of the oculomotor nerve in monkeys. J Neurol Neurosurg Psychiatry 2:285–292
Bielschowsky A (1935) Lectures on motor anomalies of the eyes. II. Paralysis of individual eye muscles. Arch Ophthalmol 13:33–59
Boghen D, Chartrand JP, La Flamme P (1979) Primary aberrant third nerve regeneration. Ann Neurol 6:415–418
Bozzoni F (1960) Su di un caso di sincinesia post-traumatica oculo-palpebrale da rigenerazione anomala del III P. NN.CR Boll Ocul 39:919–927
Coppez H (1931) Sur le pseudo-signe de Graefe (Signe de Fuchs). Arch Ophthalmol 48:385–389
Cox TA, Wurster JB, Dodfrey WA (1979) Primary aberrant oculomotor regeneration due to intracranial aneurysms. Arch Neurol 36:570–571
Cristini G (1947) Movimenti associati palpebrali e pupillari anomali da rigenerazione errata delle fibre nervose dell 'oculomotore comune (Descrizione di 3 casi). Riv Oto-Neuro-Oftalmol 22:323–334
Etzine S (1966) Congenital ptosis with paradoxic eyelid movements. Am J Ophthalmol 61:793–795
Ferreira Filho J (1947) Pseudo-Graefe phenomenon. Arch Ophthalmol 37:308–317
Forster RK, Schatz NJ, Smith JL (1969) A subtle eyelid sign in aberrant regeneration of the third nerve. Am J Ophthalmol 67:696–698
Gifford SR (1939) Paradoxic elevation of the lid. Arch Ophthalmol 22:252–256
Guy J, Engel HM, Lessner AM (1989) Acquired contralateral Oculomotor synkinesi. Arch Neurol 46:1021–1023
Hoang-Xuan-Man (1954) Signe de Fuchs ou pseudo-phéno-mène de Graefe. Bull Soc Ophtalmol Fr 67:299–312
Jain NS (1957) Synkinetic lid retraction. Br J Ophthalmol 41:247–253
Johnson LN, Pack WL (1988) Transient oculomotor nerve misdirection in a case of pituitary tumor with hemorrhage. Arch Ophthalmol 106:584–585
Keane JR (1975) Bilateral aberrant regeneration of the third cranial nerve following trauma: case report. J Neurosurg 43:95–97
Kernes JM, Smith DR, Janotta FS, Alper MG (1979) Oculomotor nerve regeneration after aneurysm surgery. Am J Ophthalmol 87:225–233
Levin PM (1952) Intracranial aneurysms. Clinicopathologic consideration of oculomotor nerve rgeneration and intracerebral hemorrhage. Arch Neurol Psychiatry 67:771–786
Martorina M, Porte E (1986) Ptosis palpébral congénital avec syncinésic oculo-palpébrale paradoxale. J Fr Ophtalmol 9:281–284
Norton E, Wetzig P (1954) Aberrant regeneration of third cranial nerve. Arch Ophthalmol 51:400–402
Peralta S (1966) Singolari forme di sincinesia durante la risoluzione di paralisi dell'oculomotore comme. Ann Ottalmol Clin Ocul 92:229–234
Ramon Y Cajal S (1928) Degeneration and regeneration of the nervous system. Oxford University Press, London
Schatz NJ, Savino PJ, Corbett JJ (1977) Primary aberrant oculomotor regeneration: a sign of cavernous meningioma. Arch Neurol 34:29–32
Sibony PA, Lessel S, Gittinger JW (1984) Acquired oculomotor synkinesis. Surv Ophthalmol 28:382–390
Trobe JD, Glaser JS, Post JD (1978) Meningiomas and aneurysms of the cavernous sinus: Neuro-ophthalmologic features. Arch Ophthalmol 96:457–467
Unsöld R, Safran AB, Safran E, Hoyt WF (1980) Metastatic infiltration of nerves in the cavernous sinus. Arch Neurol 37:59–61
Walsh FB (1957) Third nerve regeneration. A clinical evaluation. Br J Ophthalmol 41:577–598
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Martorina, M., Porté, E. Pseudo-Graefe's sign: a manifestation of aberrant regeneration of the fourth cranial nerve?. Graefe's Arch Clin Exp Ophthalmol 231, 76–78 (1993). https://doi.org/10.1007/BF00920216
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00920216