Vertical gaze palsy caused by selective unilateral infarction of rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF): A case report

Ocular Motility ◽

Internuclear Ophthalmoplegia ◽

Headache Patient ◽

Vertical Gaze ◽

Internuclear ophthalmoplegia is characterised by restricted ocular motility in lateral gaze in which the affected eye shows impairment of adduction and it results from damage to medial longitudinal fasciculus (MLF). Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is an extremely rare neurological manifestation which has typical signs including primary gaze exotropia, vertical gaze palsy, ptosis, abducting nystagmus. The common and serious etiological factor is cerebrovascular accident involving the vessels supplying MLF and many cases have life threatening associated neurological impairment. In this case report we have discussed about a gentleman who presented with bilateral ptosis, primary gaze exotropia and headache. Patient found to have vertical gaze palsy and abducting nystagmus on examination. Computed tomography (CT) imaging shows infarct in pontine region and CT angiography revealed basilar artery occlusion supplying region of pons with involvement of posterior cerebral artery. Patient treated with antiplatelet and diplopia managed. Patient showed improvement on subsequent follow-up visits.

Vertical gaze palsy and selective unilateral infarction of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF).

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.53.1.67 ◽

1990 ◽

Vol 53 (1) ◽

pp. 67-71 ◽

Cited By ~ 27

Author(s):

J Bogousslavsky ◽

J Miklossy ◽

F Regli ◽

R Janzer

Keyword(s):

Vertical Gaze ◽

Disorders of Ocular Motility Due to Disease of the Brainstem, Cerebellum, and Diencephalon

The Neurology of Eye Movements ◽

10.1093/med/9780199969289.003.0013 ◽

2015 ◽

pp. 836-915

Author(s):

R. John Leigh ◽

David S. Zee

Keyword(s):

Developmental Disorders ◽

Ocular Motility ◽

Posterior Commissure ◽

Interstitial Nucleus Of Cajal ◽

Abducens Nucleus ◽

Cerebellar Syndromes ◽

Vertical Gaze ◽

Dorsal Midbrain Syndrome ◽

This chapter reviews clinical features (with illustrative video cases) and pathophysiology of medullary lesions, including Wallenberg’s syndrome and oculopalatal tremor. Manifestations and pathophysiology of three cerebellar syndromes are described (flocculus and paraflocculus, nodulus and ventral uvula, dorsal vermis and fastigial nucleus), applying these principles to interpret the effects of developmental disorders (e.g., Chiari malformation), hereditary ataxia, paraneoplastic cerebellar degeneration, cerebellar stroke, and cerebellar tumors. Characteristics of pontine lesions are discussed, including lesions of the abducens nucleus, paramedian pontine reticular formation (PPRF), internuclear ophthalmoplegia (INO), one-and-a-half syndrome, slow horizontal saccades, and saccadic oscillations. The effects of midbrain lesions are summarized, including lesions affecting the rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF), interstitial nucleus of Cajal, posterior commissure, and more diffuse processes causing slow vertical saccades or vertical gaze palsy (dorsal midbrain syndrome), including Whipple’s disease. Effects of lesions affecting the superior colliculus, thalamus, and pulvinar are also discussed.

Unilateral thalamic infarction presenting as vertical gaze palsy: a case report

Journal of Medical Case Reports ◽

10.1186/1752-1947-5-535 ◽

2011 ◽

Vol 5 (1) ◽

Cited By ~ 2

Author(s):

Muhib Khan ◽

Christos Sidiropoulos ◽

Panayiotis Mitsias

Keyword(s):

Case Report ◽

Thalamic Infarction ◽

Vertical Gaze ◽

OPTOMETRIC MANAGEMENT OF SUPRANUCLEAR VERTICAL GAZE PALSY SECONDARY TO MIDBRAINSTROKE: A CASE REPORT.

Optometry and Vision Science ◽

10.1097/00006324-200212001-00424 ◽

2002 ◽

Vol 79 (Supplement) ◽

pp. 224

Author(s):

Christy Sell ◽

Allen Cohen

Keyword(s):

Case Report ◽

Vertical Gaze ◽

VERTICAL GAZE PALSY AFTER THALAMIC STIMULATION FOR TOURETTE SYNDROME

Neurosurgery ◽

10.1227/01.neu.0000303208.00242.a6 ◽

2007 ◽

Vol 61 (5) ◽

pp. E1100-E1100 ◽

Cited By ~ 25

Author(s):

◽

Linda Ackermans ◽

Yasin Temel ◽

Noel J.C. Bauer ◽

Veerle Visser-Vandewalle

Keyword(s):

Deep Brain Stimulation ◽

Eye Movements ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Thalamic Stimulation ◽

Pretectal Area ◽

Vertical Gaze ◽

Gaze Palsy ◽

Deep Brain

Abstract OBJECTIVE We describe a patient who developed a vertical gaze paralysis after deep brain stimulation performed for intractable Tourette syndrome due to a small deep bleeding in the upper mesencephalon. CLINICAL PRESENTATION A 39-year-old man underwent thalamic deep brain stimulation for intractable Tourette syndrome. Immediately postoperatively, he had diplopia and dizziness. The neurological examination revealed vertical gaze palsy with preserved vertical oculocephalic movements. A postoperative computed tomography scan revealed a discrete high-density lesion across the midline at the distal end of the left electrode. This area corresponds with the pretectal area, including the rostral interstitial nucleus of the medial longitudinal fasciculus, with sparing of the oculomotor and rubral nuclei. INTERVENTION Six months postoperatively, maximal upward and downward smooth pursuit eye movements were achieved. Upward saccadic velocities were still reduced by 20 to 25 degrees. CONCLUSION This case report describes a complication that might demand special attention during the planning of thalamic deep brain stimulation for the treatment of Tourette syndrome. Examination of both horizontal and vertical eye movements during deep brain stimulation surgery is recommended.