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Apraxia of eyelid closure is an uncommon condition characterized by difficulties in voluntary eye closing with normal blinking, or closing eyes in response to a perceived threat [1]. We report here a case of apraxia of eyelid closure complicating right parietal infarction.
An 81 -year-old right-handed male was hospitalized for rehabilitation of moderate left hemiparesis due to cerebral infarction. He had a past history of gastric ulcer, and hypertension at age 68. On admission, his consciousness level was alert. He showed moderate dementia, 11/30 on the Hasegawa-Dementia Score-Revised. He was normally orientated in time, place, and persons, and did not exhibit aphasia. However, he could not respond to requests to close his eyes voluntarily. Rarely, he could comply with the request to close the eyelids, however, once he could close eyelids, he could not voluntarily keep the eyelids closed for more than a few seconds. Reflex blinking in response to a visual or auditory threat or corneal stimulation was normal. Spontaneous blinking was also observed during conversation. It was also observed that the eyes closed normally in sleep. Opening of the eyelids presented no difficulties. The patient also showed constructional apraxia, and geographical agnosia. There was no dressing or ideomotor apraxia, and no left-right disorientation observed. Upward gaze was mildly restricted. Myerson's sign was positive. Bilateral corneal reflex was normal. He showed no facial muscle weakness or atrophy. He could protrude the tongue immediately when requested. Mild weakness of the left upper and lower limb was found. Deep tendon reflexes were...