INTRODUCTION Apraxia of eyelid opening (AEO) refers to impaired voluntary eyelid elevation of supranuclear origin. AEO is well-described in neurodegenerative disorders, but its frequency in stroke is unknown. METHODS To investigate the frequency of AEO after stroke, we enrolled patients with an anterior circulation occlusion admitted for endovascular thrombectomy (EVT). Exclusion criteria were posterior circulation stroke, impaired consciousness and ophthalmological disorders. Forty-eight hours after EVT, patients were screened for AEO, conjugated gaze palsies and cortical ptosis. Neurological deficits were classified using the National Institute of Health Stroke Scale (NIHSS). A blinded neuroradiologist analyzed CT brain 24 h after EVT using the Alberta Stroke Program Early CT Score. RESULTS Ninety-eight EVT patients were included in 9 months. Six patients had AEO (6%), 37 conjugated gaze palsy (38%) and 16% cortical ptosis (16%). AEO was associated with higher median NIHSS compared to no eye symptoms (18.5 vs. 3; p < 0.001) and gaze palsy or cortical ptosis (18.5 vs. 7; p = 0.003). The median modified Rankin Scale (mRS) after 3 months was 2 in patients without AEO, but 6 in patients with AEO (mRS in AEO patients nr. 1-6: 3, 4, 6, 6, 6, and 6; p = 0.015; no longer significant after adjustment for stroke severity), including 4 deaths (66%) in AEO patients. All patients with AEO had right hemisphere stroke (6/6 vs. 43/98 in total, p = 0.006). CONCLUSION AEO was observed in 6% of EVT patients who showed poor survival and outcome. AEO occurred exclusively in right hemispheric infarctions, suggesting that supranuclear eyelid control is under the influence of the right cerebral hemisphere.

中文翻译：

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中风后，开眼睑失用与高死亡率和右半球梗塞有关

简介 开眼睑失用症 (AEO) 是指核上性眼睑自主抬高受损。AEO 在神经退行性疾病中得到了很好的描述，但其在中风中的频率尚不清楚。方法 为了调查卒中后 AEO 的发生率，我们招募了前循环闭塞的患者，接受血管内血栓切除术 (EVT)。排除标准是后循环卒中、意识障碍和眼科疾病。EVT 后 48 小时，对患者进行 AEO、共轭凝视麻痹和皮质下垂的筛查。使用美国国立卫生研究院卒中量表 (NIHSS) 对神经功能缺损进行分类。一位不知情的神经放射科医生在 EVT 后 24 小时使用艾伯塔中风计划早期 CT 评分分析了 CT 大脑。结果 9 个月内共纳入了 98 名 EVT 患者。6 名患者有 AEO (6%)，37 名共轭凝视麻痹 (38%) 和 16% 皮质下垂 (16%)。与无眼部症状（18.5 对 3；p < 0.001）和凝视麻痹或皮质下垂（18.5 对 7；p = 0.003）相比，AEO 与更高的中位 NIHSS 相关。3 个月后改良 Rankin 量表 (mRS) 的中位数在没有 AEO 的患者中为 2，但在有 AEO 的患者中为 6（AEO 患者中的 mRS nr. 1-6：3、4、6、6、6 和 6；p = 0.015；在调整中风严重程度后不再显着），包括 AEO 患者中的 4 例死亡 (66%)。所有 AEO 患者都有右半球卒中（总共 6/6 对 43/98，p = 0.006）。结论 在 6% 的生存率和预后较差的 EVT 患者中观察到 AEO。AEO 仅发生在右半球梗塞中，表明核上眼睑控制受右大脑半球的影响。