Korn Thomas, Reith Wolfgang, Becker Georg
Department of Neurology, Universität des Saarlandes, Homburg/Saar, Germany.
Arch Neurol. 2004 Feb;61(2):273-5. doi: 10.1001/archneur.61.2.273.
The inability of volitional unilateral eyelid closure is an uncommon symptom of a central nervous system disorder. When it occurs as the result of a localized brain lesion, it is debated to be a form of supranuclear facial palsy or an apraxic phenomenon.
To report and discuss a unilateral (left-sided) higher-order movement disorder of the facial periocular musculature bearing apraxic features.
University neurology department.
A 78-year-old right-handed man was admitted to the hospital with a left-sided brachiofacial hemiparesis of sudden onset. After thrombolysis with intravenous recombinant tissue-type plasminogen activator, the hemiparesis, including the left-sided facial weakness, disappeared. Serial computed tomographic scans showed that the patient was left with a stroke in the right anterior cerebral artery territory, affecting the frontal commissural fibers of the corpus callosum. There were no signs of upper motor neuron facial paresis on the left side when gesturing in a natural context. Eyelid closure was complete during sleep. However, left eyelid closure and elevation of the left eyebrow were not possible on verbal command. In contrast, voluntary innervation of the perioral facial musculature was performed properly.
The voluntary-automatic dissociation of our patient's eyelid closure was suggestive of an apraxic disorder. Disconnection from a praxis center caused by callosal damage may be assumed to be the underlying cause. The unilaterality of the symptom might imply that in a bilaterally organized corticonuclear system such as upper face innervation, it is the crossing fibers that are primarily involved in praxis tasks.
自主单侧眼睑闭合功能障碍是中枢神经系统疾病的一种罕见症状。当它由局限性脑损伤引起时，对于它是核上性面瘫的一种形式还是失用现象存在争议。
报告并讨论一例具有失用特征的单侧（左侧）眼周面部肌肉高阶运动障碍。
大学神经科。
一名78岁右利手男性因突发左侧臂面部偏瘫入院。静脉注射重组组织型纤溶酶原激活剂进行溶栓治疗后，包括左侧面部无力在内的偏瘫症状消失。系列计算机断层扫描显示，患者右侧大脑前动脉区域发生中风，累及胼胝体的额连合纤维。在自然情境下做手势时，左侧没有上运动神经元性面瘫的体征。睡眠期间眼睑能够完全闭合。然而，根据言语指令无法完成左侧眼睑闭合和左侧眉毛上抬动作。相比之下，口周面部肌肉的自主神经支配功能正常。
我们患者眼睑闭合的自主 - 自动分离提示存在失用症。可以认为胼胝体损伤导致与运动中心的连接中断是其潜在病因。该症状的单侧性可能意味着，在双侧组织的皮质核系统（如支配上半面部的系统）中，主要是交叉纤维参与运动任务。
