Matthew J Thurtell1, G Michael Halmagyi. 1. Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia. matthewt@icn.usyd.edu.au
Abstract
BACKGROUND AND PURPOSE: Complete ophthalmoplegia, the combination of bilateral ptosis with loss of all extraocular movements, is rarely a consequence of ischemic stroke. We describe 3 patients who had complete ophthalmoplegia as a manifestation of bilateral paramedian midbrain-thalamic infarction, and we discuss possible pathophysiologic mechanisms. Summary of Cases- Three patients presented with coma. All had complete ophthalmoplegia that initially persisted despite improvement or fluctuation in their other deficits. MRI revealed bilateral paramedian midbrain-thalamic infarction. Two patients died, with the ophthalmoplegia remaining unchanged before death. The surviving patient had a progressive improvement in ocular abduction but persisting third nerve and vertical gaze palsies. CONCLUSIONS: Complete ophthalmoplegia is an unusual sign of bilateral paramedian midbrain-thalamic infarction. The ophthalmoplegia could result from combined third nerve, pseudoabducens, and vertical gaze palsies.
BACKGROUND AND PURPOSE: Complete ophthalmoplegia, the combination of bilateral ptosis with loss of all extraocular movements, is rarely a consequence of ischemic stroke. We describe 3 patients who had complete ophthalmoplegia as a manifestation of bilateral paramedian midbrain-thalamic infarction, and we discuss possible pathophysiologic mechanisms. Summary of Cases- Three patients presented with coma. All had complete ophthalmoplegia that initially persisted despite improvement or fluctuation in their other deficits. MRI revealed bilateral paramedian midbrain-thalamic infarction. Two patients died, with the ophthalmoplegia remaining unchanged before death. The surviving patient had a progressive improvement in ocular abduction but persisting third nerve and vertical gaze palsies. CONCLUSIONS: Complete ophthalmoplegia is an unusual sign of bilateral paramedian midbrain-thalamic infarction. The ophthalmoplegia could result from combined third nerve, pseudoabducens, and vertical gaze palsies.
Authors: Nicholas A Lazzaro; B Wright; M Castillo; N J Fischbein; C M Glastonbury; P G Hildenbrand; R H Wiggins; E P Quigley; A G Osborn Journal: AJNR Am J Neuroradiol Date: 2010-03-18 Impact factor: 3.825
Authors: Pooja Raibagkar; Ram V Chavali; Tamara B Kaplan; Jennifer A Kim; Meaghan V Nitka; Sherry H-Y Chou; Brian L Edlow Journal: Neurocrit Care Date: 2017-08 Impact factor: 3.210