RESIDENT
& FELLOW
SECTION
Section Editor
John J. Millichap, MD

Jesse M. Thon, MD
Lily Grossmann, MD
Shamik Bhattacharyya,
MD

Teaching Video NeuroImages:
Apraxia of eyelid closure following right
hemispheric infarction
Figure

Brain MRI displays right middle cerebral artery (MCA) territory infarction

Correspondence to
Dr. Thon:
Jesse.Thon@gmail.com

MRI shows a right MCA territory infarction on (A) diffusion-weighted imaging and (B) apparent diffusion coefficient
sequences.

A 56-year-old man presented following a right middle
cerebral artery territory infarction (figure). In addition
to left hemiparesis and neglect, he was unable to close
his left eye on command (video at Neurology.org),
though he was able to blink spontaneously and keep
his eyes closed during sleep. He could maintain closure
of both eyes once manually closed. Apraxia of eyelid
closure is distinguished clinically from eyelid closure
weakness by ability to blink reflexively and maintain
eyelid closure. Activation of the oculomotor cortex has
been associated with voluntary eyelid closure and
lesions in right frontal and parietal lobes with eyelid
closure apraxia.1,2
AUTHOR CONTRIBUTIONS
Jesse Thon: primary author, composed figure, clinician interviewer and
examiner in video. Lily Grossmann: contributing author, primary physician

for patient. Shamik Bhattacharyya: supervising author, attending physician
for patient, edited video.

STUDY FUNDING
No targeted funding reported.

DISCLOSURE
J. Thon and L. Grossmann report no disclosures relevant to the manuscript. S. Bhattacharyya: consultant to Advance Medical. Go to
Neurology.org for full disclosures.

REFERENCES
1. Hamano T, Kimura S, Miyao S, Teramoto J. Apraxia of
eyelid closure complicating right parietal infarction. Eur
Neurol 2001;45:122–123.
2. van Koningsbruggen MG, Peelen MV, Davies E, Rafal RD.
Neural control of voluntary eye closure: a case study and an
fMRI investigation of blinking and winking. Behav Neurol
2012;25:103–109.

Supplemental data
at Neurology.org
From Partners Neurology (J.M.T.), Massachusetts General Hospital; Department of Neurology (J.M.T., S.B.), Brigham and Women’s Hospital,
Boston; and Department of Neurology (L.G.), Boston Children’s Hospital, MA.
© 2017 American Academy of Neurology

e15

ª 2017 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

Teaching Video NeuroImages: Apraxia of eyelid closure following right hemispheric
infarction
Jesse M. Thon, Lily Grossmann and Shamik Bhattacharyya
Neurology 2017;89;e15
DOI 10.1212/WNL.0000000000004091
This information is current as of July 10, 2017
Updated Information &
Services

including high resolution figures, can be found at:
http://www.neurology.org/content/89/2/e15.full.html

Supplementary Material

Supplementary material can be found at:
http://www.neurology.org/content/suppl/2017/07/10/WNL.000000000
0004091.DC1

References

This article cites 2 articles, 0 of which you can access for free at:
http://www.neurology.org/content/89/2/e15.full.html##ref-list-1

Subspecialty Collections

This article, along with others on similar topics, appears in the
following collection(s):
All Neuro-ophthalmology
http://www.neurology.org//cgi/collection/all_neuroophthalmology
Clinical neurology examination
http://www.neurology.org//cgi/collection/clinical_neurology_examinati
on
Eyelids
http://www.neurology.org//cgi/collection/eyelids
Infarction
http://www.neurology.org//cgi/collection/infarction

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