My patient won't open his/her eyes!
- Beware of the patient who can't open his/her eyes but is otherwise awake!
- This coma mimic is the result of eyelid apraxia, which is the inability to voluntarily open eyes despite intact frontalis muscle contraction and absent oculomotor dysfunction.
- This can be seen in injuries of the nondominant hemisphere (e.g. R MCA stroke), medial frontal lobe, bilateral thalami (e.g. bilateral thalami stroke), and brainstem (e.g. progressive supranuclear palsy).
- When asking these patients to open their eyes, they may use their forehead muscles to try and raise their eyelids.