title: Complete ophthalmoplegia: an unusual sign of bilateral paramedian midbrain-thalamic infarction.
abstract: OBJECTIVE
  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.affiliation: Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia. matthewt@icn.usyd.edu.au
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thurtell
authors.forename: G Michael
authors.initials: GM
authors.lastname: Halmagyi
mesh_terms: D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008636:Mesencephalon / Q000473:pathology; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000209:etiology* / Q000473:pathology*; D013788:Thalamus / Q000473:pathology