Vertical Gaze Palsy due to Infarct at Thalamus-Basal Ganglia

Abstract

Abstract:Objective: The aim of this case report is to demonstrate a rare case of vertical gaze palsy and investigate the location and etiology of the lesion. Case Report: A 62 year-old male presented with sudden onset of inability to move his eyes vertically. Neuro-ophthalmological examination revealed vertical gaze palsy with intact vestibulo-ocular reflex. Magnetic Resonance Imaging (MRI) showed infarct at left thalamus and bilateral basal ganglia without any midbrain involvement. Antihypertensives and anti-dyslipidemic medications for 6 months failed to show any improvement. The etiology of vertical gaze palsy in this case is thought to be vascular lesion, however further follow up is needed to rule out another etiology. Conclusion: Patient with vertical gaze palsy needs thorough clinical neuro-ophthalmological examination together with neuroimaging to establish the etiology and investigate the location of the lesion. In this case, MRI revealed infarct on thalamic-basal ganglia which was considered to contribute in vertical gaze palsy by interrupting supranuclear inputs.