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[Isolated crossed superior rectus palsy in a midbrain infarction]
Tetsuro Tsukamoto1, Mitsuharu Yamamoto, Takahisa Fuse
1Department of Neurology, Numazu Rehabilitation Hospital.
Rinsho Shinkeigaku = Clinical Neurology
|July 19, 2005
Summary
A small left medial thalamic infarction caused isolated superior rectus palsy and diplopia due to damage to crossing nerve fibers. This rare presentation highlights the complex neuroanatomy of eye movement control.
Area of Science:
- Neuroscience
- Ophthalmology
- Neurology
Background:
- Isolated superior rectus palsy is a rare neurological finding.
- Diplopia and tinnitus can indicate underlying neurological dysfunction.
- Thalamic and midbrain lesions can affect cranial nerve function.
Observation:
- A 61-year-old man presented with acute onset tinnitus, diplopia, and isolated right superior rectus palsy.
- Neurological examination revealed no other deficits.
- MRI confirmed a left medial thalamic infarction extending to the rostral midbrain.
Findings:
- The lesion selectively affected decussating fibers of the oculomotor nerve complex, causing contralateral superior rectus palsy.
- Involvement of adjacent fibers may have caused a slight narrowing of the palpebral fissure.
- The patient experienced complete resolution of diplopia within two months.
Implications:
- This case demonstrates a rare cause of unilateral superior rectus palsy originating from a contralateral thalamic/midbrain infarct.
- It underscores the precise anatomical pathways involved in eye movement control.
- Understanding these pathways is crucial for diagnosing and managing complex neurological disorders affecting vision.
