[Bilateral medial medullary infarction presenting as vertical gaze palsy].
A 79-year old man noticed paresthesia in all 4 limbs, quadriplegia and dysarthria, and then developed respiratory arrest requiring mechanical ventilation. After level of consciousness was improved, vertical gaze palsy, left hemifacial palsy (central type) and quadriplegia were noted. Brain magnetic resonance imaging (MRI) on day 9 revealed bilateral upper medial medullary infarction. In general, the vertical gaze center is thought to be present in the midbrain, including the rostral interstitial nucleus of the medial longitudinal fasciculus, posterior commissure and interstitial nucleus of Cajal. Few reports have described vertical gaze palsy due to medullary lesions. The upper medial medullary lesions, particularly the paramedian tract in the medulla, may have been responsible for vertical gaze palsy in this patient.
Jikumaru
Mika
M
Department of Brain and Nerve Science (Internal Medicine 3), Oita University Faculty of Medicine.
Masuda
Teruaki
T
Ueyama
Hidetsugu
H
Sannomiya
Kunihiro
K
Kumamoto
Toshihide
T
D000368:Aged; D020520:Brain Infarction / Q000150:complications*; D004401:Dysarthria / Q000150:complications; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000150:complications; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply*; D011782:Quadriplegia / Q000150:complications; D013494:Supranuclear Palsy, Progressive / Q000209:etiology*