Isolated superior oblique palsies with electrophysiologically documented brainstem lesions.
Over a 13.5-year period, we observed 10 patients with isolated superior oblique palsies in whom electrophysiological abnormalities indicated brainstem lesions. In 7 patients unilateral masseter reflex abnormalities were seen, and were located on the side of the superior oblique palsy in 2 patients and on the opposite side in 5 patients. Two patients had slowed gain of following eye movements to the side contralateral to the superior oblique palsy. Slowed adduction saccades in the eye contralateral to the superior oblique palsy were seen in 1 patient. Clinical improvement was frequently (in 7 of 10 patients) associated with improvement or normalization of electrophysiologic findings. Magnetic resonance imaging (MRI) was normal, showing no evidence of brainstem lesions in 6 patients. Unilateral superior oblique palsy may be the only clinical sign of a brainstem lesion. Although such a cause may be underdiagnosed if based on MRI-documented lesions only, it remains a rare condition.
Thömke
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Department of Neurology, University of Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany. thoemke@neurolgie.klinik.uni-mainz.de
Hopf
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D000328:Adult; D000368:Aged; D001767:Blinking / Q000502:physiology; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology; D001933:Brain Stem / Q000473:pathology / Q000503:physiopathology*; D004558:Electric Stimulation; D004585:Electrooculography; D004594:Electrophysiology; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008406:Masseter Muscle / Q000294:innervation / Q000502:physiology; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000473:pathology / Q000503:physiopathology*; D012018:Reflex / Q000502:physiology; D012026:Reflex, Stretch / Q000502:physiology; D012307:Risk Factors; D012438:Saccades / Q000502:physiology; D014321:Trochlear Nerve / Q000473:pathology / Q000503:physiopathology