Background
Upper facial dysfunction is not generally considered a feature of central facial paralysis
after unilateral hemispheric stroke; however, weakness of eye closure (WEC) has been
observed in some cases. We aimed to investigate the frequency and characteristics
of WEC in unilateral stroke and its association with stroke prognosis.
Methods
Patients with unilateral stroke and central facial paralysis were prospectively recruited
within 7 days of onset. Facial paralysis was evaluated via the fourth item in the
National Institute of Health Stroke Scale (NIHSS-4) and the Japan Facial Score (JFS)
on admission, and at days 7, 14, 21, and 30 after stroke. Eye closure strength was
measured daily using an ergometer for 30 days after stroke. Primary outcome was assessed
using the modified Rankin Scale (mRS) at 90 and 180 days. Univariate and multivariate
analyses were performed to investigate risk factors of WEC.
Results
WEC was identified in 16 of 242 patients (6.6%). Baseline characteristics, stroke
risk factors, and lesion volume were not significantly different between patients
with and patients without WEC. Patients with WEC featured higher NIHSS-4 scores and
lower JFS between admission and at 21 days after stroke. Severe central facial paralysis
(odds ratio [OR] = 8.1, 95% confidence interval [CI] = 2.3-28.6, P = .001) and right hemispheric stroke (OR = 13.7, 95% CI = 3.7-51.2, P < .001) were potential predictors of WEC. At 180 days after stroke, patients with
WEC demonstrated a lower rate of functional independence (mRS = 0-2: 37.5% versus
72.1%, P < .001).
Conclusions
WEC, which predicts a worse functional outcome at 180 days after unilateral stroke,
demonstrates an association with severe central facial paralysis and right hemispheric
stroke.
Key Words
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Article info
Publication history
Published online: December 13, 2016
Accepted:
October 23,
2016
Received in revised form:
October 1,
2016
Received:
July 10,
2016
Footnotes
Grant support: This study was supported by grants from the Special Funds of Public Interest Research and Capacity Building of Guangdong Province (grant number 2014B020212003), and funds for the National Key Clinical Department, National Key Discipline, and Guangdong Key Laboratory for diagnosis and treatment of major neurological diseases.
J.L. and Y.C. contributed equally to the study and are joint first authors.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.10.029
Copyright
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
