Monocular ophthalmoplegia and partial supranuclear vertical gaze palsy due to unilateral paramedian rostral midbrain infarction

Contraversive Ocular Tilt Reaction with Contralesional Pseudo-Abducens Palsy in a Patient with Thalamomesencephalic Stroke

We report a patient presenting with unique neuroophthalmological features of contraversive ocular tilt reaction and concomitant contralesional pseudo-abducens palsy. Magnetic resonance imaging confirmed the presence of an acute infarct in the right thalamomesencephalic region. We discuss the clinical topography of these unique neuroophthalmological findings.

Vertical ophthalmoplegia due to a unilateral periaqueductal gray matter infarct in an adolescent

Brainstem strokes affecting the periaqueductal gray matter of the midbrain can cause vertical ophthalmoplegia. Accompanying clinical features are frequently associated and reflect the involvement of other brainstem structures. We report on an adolescent presenting with vertical gaze palsy and left mydriatic pupil as the only clinical expression of a small infarct located in the left periaqueductal gray matter. Even when the lesion was strictly unilateral, vertical ophthalmoplegia affected both eyes.