title: Periodic eyelid opening associated with burst-suppression electroencephalography due to hypoxic ischemic injury.
abstract: BACKGROUND
  We report four patients who developed periodic eyelid opening following hypoxic ischemic injury. This manuscript reviews the clinical course of our patients as well as previously published cases and discusses the neuroanatomical basis of eyelid opening.
  
  
  METHODS
  Data were collected from the patients' electronic medical record and digital electroencephalography recordings.
  
  
  RESULTS
  In all patients, periodic eyelid opening was associated with a burst-suppression pattern on electroencephalography (EEG). Rapid eyelid opening appeared with the onset of bursts, while slow eyelid closure coincided with periods of suppression. Progressive rostrocaudal deterioration in brainstem function ensued, in each case culminating in brain death.
  
  
  CONCLUSIONS
  Our experience and prior reports suggest that periodic eyelid opening following cardiac arrest is associated with a burst-suppression pattern on EEG. Since burst-suppression is highly (though not invariably) predictive of a poor outcome in this patient population, intensivists should be familiar with this neurological sign. Prospective studies are needed to define the neurophysiology of this phenomena and clarify its clinical significance.
authors.affiliation: Division of Neurology, Virginia Tech Carilion School of Medicine and Research Institute, 2 Riverside Cir, Roanoke, VA 24016, USA. ferrara.jay@gmail.com
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Ferrara
authors.forename: David J
authors.initials: DJ
authors.lastname: Houghton
authors.forename: Satish
authors.initials: S
authors.lastname: Rao
mesh_terms: D000328:Adult; D001767:Blinking / Q000502:physiology*; D001926:Brain Death / Q000175:diagnosis / Q000503:physiopathology; D001933:Brain Stem / Q000503:physiopathology*; D003128:Coma / Q000175:diagnosis / Q000503:physiopathology; D003937:Diagnosis, Differential; D018450:Disease Progression; D004569:Electroencephalography; D005143:Eyelids / Q000502:physiology*; D005260:Female; D006323:Heart Arrest; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D014743:Videotape Recording; D055815:Young Adult