J Clin Neurol.  2007 Dec;3(4):208-211. 10.3988/jcn.2007.3.4.208.

A Small Dorsal Pontine Infarction Presenting with Total Gaze Palsy Including Vertical Saccades and Pursuit

• Lee E
• Kim JS
• Kim JS
• Song HS
• Kim SM
• Kwon SU

• KMID: 1808561
• DOI: http://doi.org/10.3988/jcn.2007.3.4.208

Abstract

A small localized infarction in the dorsal pontine area can cause various eye-movement disturbances, such as abducens palsy, horizontal conjugate gaze palsy, internuclear ophthalmoplegia, and one-and-a-half syndrome. However, complete loss of vertical saccades and pursuit with horizontal gaze palsy has not been reported previously in a patient with a small pontine lesion. We report a 67-year-old man with a small dorsal caudal pontine infarct who exhibited total horizontal gaze palsy as well as loss of vertical saccades and pursuit.

Keyword

Ophthalmoplegia; Pontine infarction; Omnipause neurons

MeSH Terms

Aged
Humans
Infarction*
Ocular Motility Disorders
Ophthalmoplegia
Paralysis*
Saccades*

Figure

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  Figure 1 Photographs of eye motion in each cardinal directions demonstrate complete voluntary gaze palsy.

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  Figure 2 Initial diffusion-weighted MRI (A) and follow-up T2-weighted MRI (B) show a midline pontine infarction at the level of the abducens nuclei.

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  Figure 3 Neural substrates (A, sagittal view of brainstem B, axial view of lower pons) for eye movement. Involved lesions (red color) in this patient may have been omnipause neurons in the nucleus raphe interpositus, bilateral fascicles of facial nuclei, MLF, bilateral abducens fascicles, and/or PPRF (Asterisk indicates the location of omnipause neurons in the nucleus raphe interpositus; III, oculomotor nucleus; IV, trochlear nucleus; IV, abducens nucleus; INC, interstitial nucleus of Cajal; NPH, nucleus interpositus hypoglossi; Modified from Leigh and Zee1).

Reference

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