Clinical Manifestations

Area of Science:

• Neuroscience
• Neurology

Background:

• Eyelid apraxias, including apraxia of eyelid opening (AEO) and the rarer apraxia of eyelid closure (AEC), involve difficulties with voluntary eyelid movements.
• Corticobasal syndrome (CBS) is a progressive neurodegenerative disorder often associated with primary tauopathies like corticobasal degeneration (CBD).
• While AEO is recognized in CBS, AEC is less common, presenting a unique clinical challenge.

Purpose of the Study:

• To report a case of corticobasal syndrome (CBS) presenting with apraxia of eyelid closure (AEC).
• To discuss the potential underlying pathophysiology and neuroanatomical correlates of AEC within the context of CBS.
• To contribute to the understanding of rare movement disorders in neurodegenerative diseases.

Main Methods:

• A case report detailing a 72-year-old woman with a 5-year history of neurological symptoms including speech difficulties, parkinsonism, and apraxia.
• Neurological examination revealed apraxia of speech and apraxia of eyelid closure (AEC) with preserved reflex blinking.
• Brain MRI showed mild bifrontal and right-sided atrophy; DaT-scan was negative.

Main Results:

• The patient met criteria for possible corticobasal syndrome (CBS), with clinical presentation and atrophy patterns suggesting a 4R-tauopathy, such as corticobasal degeneration (CBD).
• Apraxia of eyelid closure (AEC) was a prominent feature, occurring alongside other CBS symptoms.
• Neuropsychological testing indicated global cognitive impairment, with specific deficits in speech and motor control.

Conclusions:

• Apraxia of eyelid closure (AEC) is a rare condition that can manifest in neurodegenerative disorders, including primary tauopathies like corticobasal degeneration (CBD).
• The findings support the association of AEC with 4R-tauopathies and suggest potential involvement of insular and frontoparietal networks.
• Further research is necessary to elucidate the lesion network of AEC and its relationship with language networks in neurodegenerative diseases.