To the Editor.—
In a recent issue of this journal (Arch Neurol 32:695, 1975), James R. Keane describes a phenomenon he terms "spastic eyelids." This clinical finding is attributed to failure of inhibition of the third nerve nuclei innervating the levator palpebrae muscles. The first case described concerns a 55-year-old man, apparently in coma, with a flaccid quadriplegia and no spontaneous respirations. The pupils were 2 mm in diameter and reacted to light. The eyes were noted to be in continuous conjugate vertical motion of irregular amplitude and frequency. No voluntary or reflex horizontal eye movements were elicited. Testing of voluntary and reflex vertical eye movements was not reported. Electroencephalogram revealed bilateral slowing initially and, later, continuous alpha wave activity that blocked for up to ten seconds with the removal of eye patches. The patient was sustained on a respirator for seven months. Pathologic findings reported thrombosis of a fusiform basilar
Reeves AG, Jenkyn LR. Eye Findings in the "Locked-In" Syndrome. Arch Neurol. 1976;33(3):215. doi:10.1001/archneur.1976.00500030071017
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