Blepharoclonus: Anatomical Localization and
Etiological Consideration
Kulthida Methawasin MD*, Roongroj Bhidayasiri MD**,
Kammant Phanthumchinda MD**, Larry Kaufman MD, FCCM, FCCP*
Affiliation :
* Division of Neurology, Department of Medicine, Faculty of Medicine,
Srinakharinwirot University Ongkharak Campus, Nakornnayok, Thailand
** Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Blepharoclonus refers to myoclonic rhythmic eyelid closure. This is an extremely rare abnormal movement of
the eyelids. The symptom has an ill-defined anatomical localization and hypothesized etiologies are diverse. We describe a
42 year-old woman with known poorly controlled hypertension (HTN) who presented with a three-week history of ataxia,
dysmetria, and uncontrolled eyelid twitching. The bilateral abnormal eyelid movement occurred during either eyelid closure
or opening, and was compatible with blepharoclonus. MRI revealed multiple cerebral infarctions at red nucleus, dentate
nucleus, and inferior olives. These foci are within Guillain-Mollaret’s triangle. The ataxia and dysmetria gradually improved
within three weeks. While the blepharoclonus improved, it persisted after one year of follow-up. Our conclusion was one
of HTN leading to a lacunar infarct that manifested partially as blepharoclonus. Due to the neuroimaging findings and
clinical course, we propose that blepharoclonus may be a variant of palatal myoclonus and may be considered as another
lacunar syndrome.
Keywords : Blepharoclonus, Guillain-Mollaret triangle, Palatal myoclonus
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