UMEM Educational Pearls

Title: My Patient Won't Open His/Her Eyes!

Category: Neurology

Keywords: eyelid apraxia, eye opening apraxia (PubMed Search)

Posted: 9/14/2016 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

 
My patient won't open his/her eyes!
 
  • Beware of the patient who can't open his/her eyes but is otherwise awake!
  • This coma mimic is the result of eyelid apraxia, which is the inability to voluntarily open eyes despite intact frontalis muscle contraction and absent oculomotor dysfunction.
  • This can be seen in injuries of the nondominant hemisphere (e.g. R MCA stroke), medial frontal lobe, bilateral thalami (e.g. bilateral thalami stroke), and brainstem (e.g. progressive supranuclear palsy).
  • When asking these patients to open their eyes, they may use their forehead muscles to try and raise their eyelids.