1/9. "Apraxia of eyelid opening" induced by levodopa therapy and apomorphine in atypical parkinsonism (possible progressive supranuclear palsy): a case report.We report a female patient in whom so-called apraxia of eyelid opening (AEO) developed after the onset of possible progressive supranuclear palsy (national institute of neurological disorders and stroke criteria) and the introduction of antiparkinsonian medications including levodopa. Although parkinsonian symptoms responded poorly to levodopa, AEO worsened after increasing levodopa dosage and disappeared when levodopa was discontinued. Later, a dose of apomorphine widely accepted for acute tests had no significant effect on limb motor activity but induced AEO. overall, these observations are grounds for thinking that AEO developing in the course of parkinsonism may be either disease- or drug-related. The possibility of manipulating dopaminergic treatment should always be considered when dealing with AEO associated with parkinsonism.- - - - - - - - - - ranking = 1keywords = parkinsonism, parkinsonian (Clic here for more details about this article) |
2/9. Improvement of apraxia of eyelid opening by wearing goggles.Apraxia of eyelid opening (ALO) is a non-paralytic motor abnormality characterised by difficulty in initiating the act of eyelid opening without blepharospasm. We found that wearing goggles improved the difficulty of opening eyes in two patients with ALO with parkinsonism. Wearing goggles is a simple method for improving daily life in patients with ALO.- - - - - - - - - - ranking = 0.13863939471899keywords = parkinsonism (Clic here for more details about this article) |
3/9. Primary central nervous system lymphoma in the SMA presenting as rapidly progressive parkinsonism.We report on a 56-year-old man who developed a rapidly progressive parkinsonism and apraxia over 2 months due to biopsy confirmed cerebral non-Hodgkin lymphoma primarily involving the SMA and parts of the superior frontal gyrus bilaterally.- - - - - - - - - - ranking = 0.69319697359495keywords = parkinsonism (Clic here for more details about this article) |
4/9. Post-encephalitic segmental dystonia with apraxia of eyelid opening.We describe a 34 year old woman presenting with a 25 year history of segmental dystonia with apraxia of eyelid opening, orofacial and focal upper limb dystonia following an episode of meningoencephalitis. Post-encephalitic apraxia of eyelid opening has not been previously reported in the absence of parkinsonian features.- - - - - - - - - - ranking = 0.084081815843032keywords = parkinsonian (Clic here for more details about this article) |
5/9. Parkinsonism and extraocular motor abnormalities with unusual neuropathological findings.Parkinsonian patients with ocular motility abnormalities are usually considered to have progressive supranuclear palsy. However, a number of other conditions have been noted to have the combination of parkinsonism and ocular problems. We report a case of rigid akinetic parkinsonism, oculomotor palsy, and eyelid apraxia with postmortem examination. Our findings are unusual in that there was marked gliosis of the substantia nigra with a large amount of free extracellular neuromelanin despite a 3-year clinical course. Only rare hyaline inclusion bodies and no neurofibrillary tangles were seen in the brainstem. Excessive calcification of the vessels of the globus pallidus were also noted. This case represents another example of the diversity of conditions producing parkinsonism with extraocular motor abnormalities.- - - - - - - - - - ranking = 0.41591818415697keywords = parkinsonism (Clic here for more details about this article) |
6/9. L-threo-3,4-dihydroxyphenylserine treatment for gait apraxia in parkinsonian patients.L-threo-3,4-dihydroxyphenylserine (L-DOPS) was administered to six parkinsonian patients for the treatment of gait related akinesia which was refractile to L-DOPA treatment. One responded with marked improvement and one with only mild improvement. Although number of patients who respond markedly to this noradrenaline precursor, L-DOPS, is limited, L-DOPS was felt to be the most effective treatment modality for L-DOPA refractile gait related akinesia and L-DOPA related orthostatic hypotension.- - - - - - - - - - ranking = 0.42040907921516keywords = parkinsonian (Clic here for more details about this article) |
7/9. "Apraxia" of eyelid opening: an involuntary levator inhibition.Apraxia of lid opening was described by Goldstein and Cogan as "a non paralytic motor abnormality characterized by the patient's difficulty in initiating the act of lid elevation." We studied six such patients with this finding accompanied by vigorous frontalis contraction and no evidence of ongoing orbicularis oculi contraction, dysfunction of the oculomotor nerve, or loss of ocular sympathetic innervation. Four patients had Parkinson's disease or atypical parkinsonism, one had progressive supranuclear palsy, and one had shy-drager syndrome. At onset of ocular symptoms, mean age was 64 years, and the mean duration of extrapyramidal symptoms was 9.7 years. By definition, the motor system must be intact in any apraxia. Therefore, this disorder of lid opening in patients with extrapyramidal motor dysfunction is not an apraxia, but rather involuntary levator palpebrae inhibition of supranuclear origin.- - - - - - - - - - ranking = 0.13863939471899keywords = parkinsonism (Clic here for more details about this article) |
8/9. Botulinum toxin treatment of apraxia of eyelid opening in progressive supranuclear palsy: report of two cases.We report two patients, with postural instability and dystonic parkinsonism whose adjunctive disabling feature was blindness due to an inability to reopen the eyes after voluntary closure of the eyelids, as in apraxia of lid opening (ALO). Supranuclear downgaze paresis permitted the diagnosis of progressive supranuclear palsy (PSP) in one case. Electromyographic studies showed a loss of normal reciprocal inhibition between the levator palpebrae and the pretarsal portion of the orbicularis oculi, with a cocontraction of these two antagonist muscles. The evoked blink reflex, tested with the paired shock technique, showed enhanced recovery of R2 response. Botulinum toxin A injections directed toward the junction of the preseptal and pretarsal parts of the palpebral orbicularis oculi muscle improved eyelid motility in both patients. Successive static and dynamic balance training and development of compensatory strategies for visual scanning deficits reduced gait imbalance, the number of falls, and the disability level as measured on the Northwestern University Disability Scale.- - - - - - - - - - ranking = 0.13863939471899keywords = parkinsonism (Clic here for more details about this article) |
9/9. Supranuclear gaze palsy and eyelid apraxia in postencephalitic parkinsonism.We describe six patients with clinicopathologically confirmed post-encephalitic parkinsonism (PEP) in whom oculomotor abnormalities developed several years after suffering the initial episode of encephalitis lethargica. Four of the cases had vertical supranuclear gaze palsy and two eyelid apraxia, features typically associated with progressive supranuclear palsy (PSP). Our findings indicate that the presence of gaze palsy alone may not be a reliable clinical discriminator between PEP and PSP. Involvement of the dorsal central gray nucleus, nucleus centralis pontis oralis, nucleus dorsal raphe interpositus, rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), nucleus interstitialis of Cajal, nucleus of the posterior commissure, pedunculopontine nuclei and frontal cortex was observed in several of our PEP cases and may contribute to the oculomotor abnormalities in this disorder. Whether the dorsal tegmental nucleus, caudal to the supratrochlear nucleus, severely affected in all our PEP cases, has a role in vertical gaze needs to be further studied.- - - - - - - - - - ranking = 0.69319697359495keywords = parkinsonism (Clic here for more details about this article) |