Bielschowsky's Symptom

Bielschowsky's sign is a symptom described by the German ophthalmologist Alfred Bielschowsky (1871-1940).

The essence of the symptom is as follows: when trying to raise the eyes upward, the patient experiences involuntary downward movements of the eyeballs. This symptom indicates damage to the oculomotor nerves or oculomotor nerve nuclei.

The causes of Bielschow's symptom can be different:

1. Stroke in the brainstem
2. Brain stem tumors
3. Multiple sclerosis
4. Neurodegenerative diseases (Parkinson's disease, progressive supranuclear palsy)

To confirm the diagnosis, additional examinations are performed - MRI or CT scan of the brain. Treatment depends on the cause of the symptom.

Thus, Bielschowsky's symptom is an important diagnostic sign of brain stem damage. Timely recognition of this symptom helps to correctly diagnose and prescribe adequate treatment.

Bielschow's symptom **Bielschow's** symptom is an ophthalmological diagnostic test that is used to determine the condition of the eyeballs and adnexal organs. This research method is based on the difference in pressure at the base of the eye and the palpebral fissure. The name of the method is associated with the name of the German ophthalmologist Eugen Bielschowski (September 12, 1825 - December 28, 1911), who discovered this method.

The name of the procedure is an abbreviation of the original name used by Bielschowski - “sinus eye pad”. French ophthalmologist Maurice Inard called this method the “adnexal organ method” or “sinus method,” and Italian ophthalmologists developed more modern terms: sinus-eye test and adnexal nodule test.

Despite the abundance of synonyms, the essence and name of the method do not change. During the diagnostic process, the patient sitting at the table looks straight ahead or fixes his gaze on the doctor's eye. At the moment when the doctor presses on the lateral ends of the eye eyebrows, the pressure force decreases very gradually. After this, the doctor again presses his index fingers (thumb, then middle finger) on the middle of the eyebrows and looks at the sinus area, then at the open eye, checking the functionality of the cornea and pupil. If there is a decrease in the diameter of the pupil towards the patient’s nose, the doctor notes the presence of pupil divergence (insufficient reflex contraction of the pupil) and believes that the cause is dystopia (abnormal position), retroposition (rotation of the base of the eyeball outwards), and a small degree of descending cataract.

Ophthalmologists pay special attention to the Bielschow symptom, especially when examining children, since problems arise most often in cases where the doctor does not know what signs indicate the need for research using a probe ophthalmoscope and how carefully the doctor can control its actions. Also, knowledge of this method significantly influences the assessment of the child’s condition during neuro-ophthalmological studies performed during examination for cerebral vascular pathology. In this case, the method is used especially effectively when paralysis is associated with significant difficulty in movements, and constant dilation of the pupils can also be observed. With Bielschowsky's symptom, myopia is detected in cases of changes in the retrobulbar space. The combination of Bielszewski's symptom and mydriasis indicates pathology of the brain and upper shoulder girdle. Bielszewski's sign and accommodation indicate retrobulbar pathology.