Summary
A patient with infarction of the paramedian part of the lower mid-brain on the right side is described, in whom internuclear ophthalmoplegia and bilateral ptosis were associated with limitation of elevation of the contralateral eye from paresis of the superior rectus. Supranuclear paresis was suggested by partial dissociation between phasic and tonic components of upward gaze. It is suggested that the right-sided lesion involved the rostral median longitudinal fasciculus before it reached the oculomotor nucleus, the central caudal nucleus medially situated in the lower end of the oculomotor nucleus, and the prenuclear fibres from the posterior commissure to the ipsilateral nucleus of the contralateral superior rectus. A supranuclear lesion may be suspected when there is a complex association of dysconjugate palsy of oculomotor muscles.
Zusammenfassung
Es wurde eine Patientin mit Infarkt des paramedianen Teils des unteren Mittelhirns rechts untersucht. Es lag eine internukleäre Ophthalmoplegie und eine bilaterale Ptose mit Heberschwäche des kontralateralen Auges bei Parese des M. rectus superior vor. Wegen einer partiellen Dissoziation von phasischen und tonischen Komponenten der Heberfunktion vermuteten wir eine supranukleäre Parese. Die Läsion umfaßt wahrscheinlich rechts das rostrale mediale Längsbündel, den zentralen caudalen Teil des Nucleus oculomotorius und die prenucleären Fasern der Commisura posterior.
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Bogousslavsky, J., Regli, F., Ghika, J. et al. Internuclear ophthalmoplegia, prenuclear paresis of contralateral superior rectus, and bilateral ptosis. J Neurol 230, 197–203 (1983). https://doi.org/10.1007/BF00313631
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DOI: https://doi.org/10.1007/BF00313631