Apraxia of lid opening due to a small lesion in basal ganglia: two case reports

The apraxia of lid opening (ALO), a synonym for apraxia of eye opening, is a disabling syndrome characterised by an inability to open the eyes at will, and patients sometimes try to open their eyes by contracting the frontalis muscles and touching their eye lids with their own fingers (sensory trick). This symptom is often associated with blepharospasm and/or ptosis and sometimes seen in patients with Parkinson's disease or other movement disorders. These reports suggest that ALO may be produced by some lesions at the basal ganglia. To determine specific sites responsible for some symptoms, patients with the target symptoms resulting from a small cerebrovascular lesion usually can provide us with useful information. However, the ALO is rarely produced by a single cerebrovascular lesion.1 A few patients with ALO had a large ischaemic lesion at the non-dominant side in the middle cerebral artery territory.1 One case report described a small lesion at the putamen causing ALO.2 Here, we present two patients with ALO due to a small lesion in the basal ganglia and discuss mechanisms for ALO. On 10 December 2008, patient 1 developed right hemiparesis and had difficulty in opening her eyes. A brain CT showed …