on February 28, 2008
Published online before print February 28, 2008, doi: 10.1161/STROKEAHA.107.504761
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Submitted on September 17, 2007
From the Department of Neurology, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia. * To whom correspondence should be addressed. E-mail: matthewt{at}icn.usyd.edu.au.
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.
Accepted on September 21, 2007
Complete Ophthalmoplegia. An Unusual Sign of Bilateral Paramedian Midbrain-Thalamic Infarction
Matthew J. Thurtell MBBS, FRACP* and G. Michael Halmagyi MD, FRACP
Key words: ophthalmoplegia • mesencephalon • thalamus • infarction