Joffroy sign

Joffroy sign: absent wrinkling of the forehead when a patient in patients Graves Ophthalmopathy looks up with the head bent forwards.

History

1893 – Alix Joffroy presented a lecture at the Hospice de la. Salpêtrière on the epidemiology and treatment of exophthalmic goitre by request of Jean-Martin Charcot.

‘J’ai saisi cette occasion avec d’autant plus d’empressement que les idées que je vais exposer sont loin d’être généralement adoptées et qu’il y a lieu, en conséquence, de leur donner une plus grande publicité et de susciter autour d’elles une discussion plus générale…’

Along with general observations of clinical signs in Graves Ophthalmopathy, Joffroy made particular mention of a new sign ‘Paralasie des muscles de la partie supérieure de la face‘

‘Paralysis of the muscles of the upper part of the face:

In our patient, these muscles are affected in a rather unique way that I have already encountered in three other cases, without this particularity having been so far reported. When the eyes are rotated upwards, normally there occurs a synergistic contraction of the elevator of the lids, and a contraction of the frontalis with concomitant wrinkling of the skin of the forehead. However in these cases, the synergistic action is disturbed, the frontalis does not contract and there is an absence of wrinkling of the skin of the forehead. The frontalis that is paralyzed, as the patient can perform voluntary eyebrow movements.’ [Joffroy 1893:479]