Internuclear ophthalmoplegia, prenuclear paresis of contralateral superior rectus, and bilateral ptosis

Bogousslavsky, Julien; Régli, F; Ghika, J.; Hungerbühler, J P

doi:10.1007/bf00313631

Cited by 33 publications

(9 citation statements)

References 19 publications

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“…However, the patient's contralateral eye was not hypotropic on straight gaze, and there was a limitation of the eye movements in the inferior oblique direction, both of which support a diagnosis of supranuclear upward gaze defect. Patients with nuclear lesions with 17 or without 16 involvement of the contralateral superior rectus have been reported, and Bogousslavsky et al 27 described a patient with midbrain infarction that caused contralateral superior rectus paresis, probably due to the involvement of the prenuclear fibers.…”

Section: Discussionmentioning

confidence: 99%

Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke.

Kim

Kang

Lee

et al. 1993

Stroke

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Background and Purpose: There have been few reports of strokes producing isolated or predominant ocular motor nerve palsies as a clinical manifestation.Methods: We studied seven patients with brain stem stroke who had ocular motor palsies as the only or the predominant neurological manifestation, and we correlated their clinical features with radiological findings.Results: Five patients had small strokes in the area of oculomotor nuclei or fascicles and showed various combinations of oculomotor disturbances. Three of these patients showed vertical gaze paresis of the opposite eye. One patient with a small hemorrhage near the aqueduct of Sylvius showed fourth nerve palsy on the contralateral side, and a patient with a small infarct in the pontine tegmentum showed isolated sixth nerve palsy. Nonocular minor neurological signs included trigeminal sensory changes in four patients and clumsy arm in two. Ocular and nonocular dysfunctions generally improved within several months. Radiological findings of the brain stem correlated well with the ocular signs.Conclusions: We conclude that acute brain stem stroke should be included in the differential diagnosis of isolated ocular motor nerve palsies and that appropriate diagnostic investigations should be performed in these cases.

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Section: Discussionmentioning

confidence: 99%

Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke.

Kim

Kang

Lee

et al. 1993

Stroke

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“…6 Specific ocular motor signs, mainly third-nerve palsy, may help to identify and localize the mesencephalic infarct, whereas in the presence of multiple and extended infarcts in the posterior circulation, MRI can give valuable information about the lesion side. Paramedian infarcts are often associated with nuclear syndrome of the third nerve, [21][22][23][24][25] whereas more lateral infarcts led to the fascicular lesions of the third nerve, either in isolation or with contralateral hemiparesis or hemiataxia. 3,4,9,26 -31 Fascicular third-nerve involvement resulting from a mesencephalic lesion may not be easily differentiated from a peripheral lesion, also because of the common lack of associated central neurological dysfunction(s).…”

Section: Kumral Et Al Mesencephalic and Associated Infarcts 2229mentioning

confidence: 99%

Mesencephalic and Associated Posterior Circulation Infarcts

Kumral

Bayülkem

Akyol

et al. 2002

Stroke

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Background and Purpose-The purposes of this study were to evaluate and review the risk factors and clinical features of patients with posterior circulation stroke involving mesencephalon and neighboring structures and to describe the clinical syndromes according to the mesencephalic arterial territory involved. Methods-We studied all patients with acute posterior circulation stroke involving mesencephalon who were admitted consecutively to our stroke unit over a 6-year period. We selected these patients (3%) from 1296 patients with posterior circulation infarct. Neurological and radiological investigations, including MRI and angiography, were performed in all cases. We classified patients into 4 groups on the basis of MRI findings: (1) isolated mesencephalic infarcts (9 patients); (2) distal territory infarcts (19 patients), including mesencephalon, thalamus, medial temporal and occipital lobes, and cerebellum; (3) middle territory infarcts (12 patients), including the pons and anterior inferior cerebellar artery territory; and (4) proximal territory infarcts (1 patient), including the medulla and posterior inferior cerebellar artery territory. Results-Middle mesencephalon involvement was the most common in all groups, and the anteromedial territory was frequently affected, depending on the direct perforators of basilar artery. In patients with isolated mesencephalic infarct, the clinical picture was dominated by nuclear or fascicular third-nerve palsy and contralateral motor deficits. The distal territory involvement was the most common and associated with consciousness disturbances, gait ataxia, ocular motor disturbances, and visual field deficits. The neurological picture of middle territory infarcts was dominated by consciousness disturbances with dysarthria, horizontal ocular motor disorders, and hemiparesis. Proximal territory involvement was rare and associated with acute unsteadiness, vertigo, dysphagia, dysphonia, tetra-ataxia, and motor weakness. The most common cause of stroke was large-artery disease in 16 patients (39%), cardioembolism in 8 (20%), and small-artery disease with lacunar mesencephalic infarct in 10 (24%). Bilateral mesencephalic infarcts were not uncommon (27%), mainly in patients with multiple and extended infarcts in the posterior circulation, and were associated with poor outcome compared with unilateral infarct. Conclusions-Our study highlights the topographic and clinical heterogeneity of the acute posterior circulation infarcts involving mesencephalon. The variety of the underlying potential causes of stroke requires detailed investigations of the extra and intracranial arteries and the heart.

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“…Bilateral vertical gaze palsy, or the vertical one-and-a-half syndrome, was previously described in thalamic lesions. 1 3 14 Monocular elevation palsy with internuclear ophthalmoplegia and ptosis have been described in one case, 15 and monocular elevation paresis for both saccade and pursuit movements in another, 16 dependent on paramedian or lower midbrain lesions.…”

Section: Discussionmentioning

confidence: 99%

Clinically evidenced unilateral dissociation of saccades and pursuit eye movements

Onofrj

Iacono²,

Luciano³

et al. 2004

Journal of Neurology, Neurosurgery & Psychiatry

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A patient affected by an ischaemic lesion of the right medial thalamic nucleus presented with a uniocular dissociation of upward vertical saccades and pursuit movement, with absent upward vertical saccades in the left eye. Clinical observations were confirmed by magnetic field scleral search coils analysis. During the vertical eye movement the patient denied any diplopia, thus suggesting a transient visual suppression in the left eye.

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Internuclear ophthalmoplegia, prenuclear paresis of contralateral superior rectus, and bilateral ptosis

Cited by 33 publications

References 19 publications

Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke.

Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke.

Mesencephalic and Associated Posterior Circulation Infarcts

Clinically evidenced unilateral dissociation of saccades and pursuit eye movements

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