Disclosures: Nicholas C. Elwert, DO: No financial relationships or conflicts of interest

Case Description: A 49-year-old Hispanic male who presented to the acute care hospital as a transfer with an acute ischemic stroke status post thrombectomy, with left internal carotid artery dissection and failed stent placement. Computed tomography of the head demonstrated significant cerebral edema with rightward midline shift requiring hemicraniectomy. Magnetic Resonance Imaging showed a large left MCA territory infarct involving the medial and inferior frontal gyri, basal ganglia, and the temporal and parietal lobes. Upon admission to acute rehabilitation, the patient presented with right-sided hemineglect and hemiplegia. Additionally, the patient presented with an inability to voluntarily open his eyes bilaterally which was determined to be apraxia of eyelid opening (AEO). After review of the pathophysiology of AEO, he was started on carbidopa/levodopa therapy.

Setting: Inpatient Rehabilitation Facility

Patient: A 49-year-old male with apraxia of eyelid opening in acute ischemic stroke Assessment/

Results: The day after carbidopa/levodopa initiation, he voluntarily opened his eyes on command. After three doses (10mg/100mg), he was able to open and close his eyes at will for five minute intervals. The dose was increased to 25mg/250mg after five days and the patient progressed to being able to open and close his eyes at will throughout his therapy sessions. At discharge, he was able to open and close his eyes throughout the majority of the day.

Discussion: AEO is defined as a non-paralytic inability to voluntarily open the eyes. It is most commonly described in patients with extrapyramidal diseases. However, in cases where there is association with cerebral infarct, lesions typically occurred in the basal ganglia. It is thought the primary motor cortex, the supplementary motor and the basal ganglia are involved in eyelid opening.

Conclusion: This case shows that AEO can occur after acute ischemic stroke of the basal ganglia, in the absence of extrapyramidal diseases, and can be successfully treated with dopaminergic medications.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2020

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/apraxia-of-eyelid-opening-in-acute-ischemic-stroke-a-case-report/