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Conjugate Eye Deviation Caused by Upper Medial Medullary Infarction: A Case Report
Takashi Ogawa1, Yuji Ueno1, Hikaru Kamo1
1Department of Neurology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan.
Summary
Conjugate eye deviation (CED) can result from brainstem lesions. This study details a rare case of CED to the contralesional side in a patient with upper medial medullary infarction affecting the nucleus prepositus hypoglossi and inferior olivary nucleus.
Area of Science:
- Neurology
- Neuroscience
- Ophthalmology
Background:
- Conjugate eye deviation (CED) is a neurological sign characterized by sustained horizontal gaze deviation and gaze palsy.
- Lesions in the brainstem, basal ganglia, or frontal eye fields typically cause CED.
- Reports of CED in medullary infarction are scarce.
Observation:
- A 76-year-old woman presented with acute vertigo, right hemiparesis, and CED to the right with leftward gaze palsy.
- Brain MRI revealed left upper medial medullary infarction involving the nucleus prepositus hypoglossi (NPH) and inferior olivary nucleus (ION).
Findings:
- The NPH and ION are crucial components of the NPH-ION-flocculus-vestibular nucleus loop, regulating horizontal eye movements.
- Damage to these nuclei may disrupt inhibitory and excitatory pathways, leading to CED.
- This case demonstrates CED to the contralesional side, a rare presentation in upper medial medullary infarction.
Implications:
- This case expands the understanding of CED's etiology, particularly in medullary infarction.
- Highlights the role of the NPH-ION complex in horizontal gaze control.
- Suggests the need for careful neuro-ophthalmological evaluation in patients with medullary stroke.
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