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Stroke. 2008 Apr;39(4):1355-7. doi: 10.1161/STROKEAHA.107.504761. Epub 2008 Feb 28.

Complete ophthalmoplegia: an unusual sign of bilateral paramedian midbrain-thalamic infarction.

Author information

1
Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia. matthewt@icn.usyd.edu.au

Abstract

BACKGROUND AND PURPOSE:

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.

PMID:
18309144
DOI:
10.1161/STROKEAHA.107.504761
[Indexed for MEDLINE]

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