title: Weakness of Eye Closure with Central Facial Paralysis after Unilateral Hemispheric Stroke Predicts a Worse Outcome.
abstract: 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.
authors.affiliation: Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Jianwen
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Yicong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Wen
authors.affiliation: Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Zhiyun
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China. Electronic address: zengjs@pub.guangzhou.gd.cn.
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004576:Electromyography; D005158:Facial Paralysis / Q000209:etiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D015835:Ocular Motility Disorders / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D013997:Time Factors; D055815:Young Adult
keywords: Stroke; central facial paralysis; factor; outcome; risk; weakness of eye closure