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Related Experiment Videos

Abnormal vergence with upper brainstem infarcts: pseudoabducens palsy.

P Pullicino1, N Lincoff, B T Truax

  • 1Department of Neurology, State University of New York at Buffalo 14203, USA. ppullici@acsu.buffalo.edu

Neurology
|August 10, 2000
PubMed
Summary

Brainstem infarcts can cause pseudoabducens palsy and convergence-retraction nystagmus (CRN). Lesions near the midbrain-diencephalic junction are key to developing these vergence abnormalities.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Neurology

Background:

  • Rostral brainstem infarcts commonly cause vertical gaze palsies.
  • They can also lead to inappropriate convergence, presenting as pseudoabducens palsy and convergence-retraction nystagmus (CRN).
  • The precise human neural substrate for vergence remains undefined.

Observation:

  • Seven patients with pseudoabducens palsy and "top-of-the-basilar" infarction were analyzed.
  • Clinical features, ocular findings, and neuroimaging (CT/MR) data were reviewed.
  • Literature review included cases with autopsy-localized infarcts causing pseudoabducens palsy or CRN.

Findings:

  • Smallest infarcts causing ipsilateral pseudoabducens palsy and CRN were near the midbrain-diencephalic junction, rostral to the oculomotor nucleus.

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  • Contralateral pseudoabducens palsy correlated with subthalamic and thalamic infarcts.
  • Larger midbrain infarcts caused bilateral pseudoabducens palsy; all patients had upgaze palsy.

    • Implications:

    • Lesions in the midbrain-diencephalic junction region are critical for pseudoabducens palsy development.
    • Pseudoabducens palsy and CRN likely represent shared mechanisms of abnormal vergence.
    • Descending inhibitory pathways for convergence may involve the thalamus and subthalamic region.