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Updated: Mar 15, 2026
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DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions
Published on: August 26, 2014
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Pathways Linked to Internuclear Ophthalmoplegia on Diffusion-Tensor Imaging in a Case with Midbrain Infarction
Haruka Takeshige1, Yuji Ueno1, Koji Kamagata2
1Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
Summary
This study presents a case of bilateral internuclear ophthalmoplegia in a patient with juvenile mixed connective tissue disease, linked to midbrain infarction. Diffusion tensor imaging identified the affected medial longitudinal fasciculus, aiding diagnosis and treatment.
Area of Science:
- Neuroscience
- Ophthalmology
- Rheumatology
Background:
- Midbrain infarction can cause varied ophthalmoplegia, but specific microanatomical correlations are underexplored.
- This study investigates the pathological fiber tracts in a patient with ophthalmoplegia using diffusion tensor imaging (DTI).
Observation:
- A 21-year-old woman with mixed connective tissue disease (MCTD) developed bilateral internuclear ophthalmoplegia (INO) with upward gaze and convergence palsies.
- Diffusion-weighted imaging revealed an acute ischemic lesion in the periaqueductal gray matter.
Findings:
- DTI showed reduced fractional anisotropy and increased apparent diffusion coefficient in the left medial longitudinal fasciculus (MLF) tract from the midbrain to the posterior commissure (PC).
- These DTI findings suggest vasculitis-induced midbrain infarction affecting the MLF-PC pathway.
Implications:
- This is the first reported case of juvenile MCTD-associated bilateral INO due to midbrain infarction and vasculitis.
- DTI may be valuable in identifying specific fiber tract pathologies in midbrain infarction with ophthalmoplegia.
