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LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 3  |  Page : 404-405

Blinking of the eye on voluntary movement on the side of paralysis in a case of cerebrovascular accident


Dr. Bhagwant Rai Neurology Clinic, Circular Road, Amritsar, Punjab, India

Date of Acceptance20-Jul-2002

Correspondence Address:
118 - A, Gopal Nagar, Majitha Road, Amritsar- 143001 (Punjab), India
[email protected]



How to cite this article:
Vasudeva S, Rai B, Vasudeva R. Blinking of the eye on voluntary movement on the side of paralysis in a case of cerebrovascular accident. Neurol India 2004;52:404-5


How to cite this URL:
Vasudeva S, Rai B, Vasudeva R. Blinking of the eye on voluntary movement on the side of paralysis in a case of cerebrovascular accident. Neurol India [serial online] 2004 [cited 2020 Dec 1];52:404-5. Available from: https://www.neurologyindia.com/text.asp?2004/52/3/404/12762


Sir
Cerebellar ataxia and hemiparesis are common with lesions in the region of the internal capsule.[1] The palmo-ocular reflex is not so well recognized or reported.
A 40-year-old, non-diabetic or hypertensive male patient was admitted after about 24 hours of sudden onset of slurring of speech disturbance and weakness of the right side of the body. The weakness was more pronounced in the leg. The neurological examination revealed that the power was Grade 4 in the right-sided limbs. The deep tendon reflexes were brisk on the right side and plantar reflex was extensor on the right side. There was no sensory deficit. The finger nose and knee heal test demonstrated ataxia on the right side which appeared out of proportion to the weakness. The patient was observed to have blinking of the right eye when he was asked to move his right hand for passive physiotherapy. The blinking and tremors of the right hand were more pronounced when the hand movements were carried out nearer to the face.
CT scan brain showed a fresh non-hemorrhagic infarct in the territory of the left middle cerebral artery and affecting the region of the ipsilateral corpus striatum and corona radiata. In addition there was an old infarct in the right middle cerebral artery territory affecting the regions of the lentiform nucleus and corona radiata. Another old lacunar infarct was observed in the left lentiform nucleus.
The exact explanation of the cause of the "palmo-ocular" reflex is unclear. However, affection of frontopontine fibers in the anterior limb of the internal capsule and activation of the red nucleus as an alternative pathway for transmitting cortical signals to the spinal cord (corticorubrospinal pathway) could be the cause. This could also explain the cause of tremors in the right hand which increased in frequency as the hand approached the face, as the red nucleus has a similar relation with the cerebellum as that of the cerebral cortex with the cerebellum. 

  References Top

1.Helgason CM, Wilbur AC. Capsular hypaesthetic ataxic hemiparesis. Stroke 1990;21:24.  Back to cited text no. 1    

 

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Online since 20th March '04
Published by Wolters Kluwer - Medknow