[Bilateral ptosis and upper gaze palsy with pupil sparing caused by midbrain hemorrhage].
The arrangement within the midbrain oculomotor nerve complex and crossed innervation of the superior rectus muscle are not elucidated in humans. A 65-year-old woman visited our hospital complaining of difficulty opening her eyes. Neurological examination revealed bilateral ptosis and impaired supraduction. The pupils prompty constricted to light. Results of CT and MRI demonstrated that there was a hematoma located in the dorsal midbrain tegmentum that spared the rostral mid-brain. It was presumed that the nerves of the superior rectus and levator palpebrae lie in the midbrain tegmentum more dorsally and medially than the others. Furthermore, crossed innervation of the superior rectus muscle can explain that lesions located in the dorsal midbrain tegmentum cause more often impaired supraduction.
Takeuchi
Satoru
S
Department of Neurosurgery, Hakodate Red Cross Hospital, 6-21 Horikawa-cho, Hakodate-shi, Hokkaido 040-8631, Japan.
Kawaguchi
Tsutomu
T
Nakatani
Mitsuru
M
Ootani
Naoki
N
Ishihara
Hideaki
H
Uozumi
Yoichi
Y
Miyazawa
Ryuji
R
Kato
Hiroshi
H
Tsuzuki
Shinsuke
S
Nawashiro
Hiroshi
H
Shima
Katsuji
K
D000368:Aged; D001763:Blepharoptosis / Q000209:etiology*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008636:Mesencephalon; D015840:Oculomotor Nerve Diseases / Q000209:etiology*; D011680:Pupil; D014057:Tomography, X-Ray Computed