Monocular elevation paresis and contralateral downgaze paresis from unilateral mesodiencephalic infarction.
A 26 year old woman presented with monocular elevation paresis of the right eye, contralateral paresis of downward gaze, and subtle bilateral ptosis. Magnetic resonance imaging disclosed a unilateral embolic infarction restricted to the mesodiencephalic junction involving the left paramedian thalamus. Preserved vertical oculocephalic movements and intact Bell's phenomenon suggested a supranuclear lesion. This rare "crossed vertical gaze paresis" results from a lesion near the oculomotor nucleus affecting ipsilateral downward gaze and contralateral upward gaze fibres, originating in the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF).
Wiest
G
G
Department of Neurology, University of Vienna, Austria.
Baumgartner
C
C
Schnider
P
P
Trattnig
S
S
Deecke
L
L
Mueller
C
C
D000328:Adult; D002544:Cerebral Infarction / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008636:Mesencephalon / Q000473:pathology / Q000503:physiopathology*; D015835:Ocular Motility Disorders / Q000473:pathology / Q000503:physiopathology*; D010291:Paresis / Q000503:physiopathology*