Ann Rehabil Med.  2014 Dec;38(6):847-851. 10.5535/arm.2014.38.6.847.

Apraxia of Eyelid Opening After Brain Injury: A Case Report

• Kim MJ
• Kim SJ
• Kim BR
• Lee J

• KMID: 2267097
• DOI: http://doi.org/10.5535/arm.2014.38.6.847

Abstract

Apraxia of eyelid opening (AEO) is a syndrome characterized by the patient's difficulty in initiating eyelid elevation spontaneously. Most of the reported cases were associated with extrapyramidal diseases. We report a case of AEO presented after traumatic brain injury, not with extrapyramidal diseases, and improved by dopaminergic treatment. A 49-year-old man underwent a traffic accident and was transferred to the emergency room in an unconscious state. Brain computed tomography (CT) revealed a subdural and epidural hemorrhage at right temporal and bilateral frontal lobes, and he received burr-hole trephination. After receiving comprehensive treatment including occupational therapy, cognition and mobility gradually improved, but he could not open his eyes voluntarily. With dopaminergic treatment (levodopa/benserazide 200/50 mg), he started to open his eyes spontaneously, especially when eating and undergoing physical training. This case showed that AEO may occur after brain injury and that dopaminergic treatment is beneficial also in AEO patients without extrapyramidal diseases.

Keyword

Apraxia of eyelid opening; Brain injury; Agents; Dopaminergic

MeSH Terms

Accidents, Traffic
Apraxias*
Brain
Brain Injuries*
Cognition
Eating
Emergency Service, Hospital
Eyelids*
Frontal Lobe
Hemorrhage
Humans
Middle Aged
Occupational Therapy
Trephining
Unconsciousness

Figure

• 

  Fig. 1 Brain images of a 49-year-old man after a traffic accident. (A-C) Axial brain computed tomography images and (D) an axial T1 FLAIR brain magnetic resonance image show bifrontal convexity of epidural hematoma (EDH), right frontal EDH, and hemorrhagic frontotemporal cerebral contusion.

• 

  Fig. 2 Effectiveness of dopaminergic treatment. (A) Before the treatment, the patient could not open his eyes voluntarily. (B-D) After the dopaminergic treatment, spontaneous eyelid opening was observed.

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