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Acute thalamic esotropia.

C R Gomez1, S M Gomez, J B Selhorst

  • 1Department of Neurology, St. Louis University School of Medicine, MO.

Neurology
|November 1, 1988
PubMed
Summary
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Acute esotropia and altered consciousness in three men were linked to posterior thalamus lesions. These findings suggest basilar artery embolism as a cause of these specific neurological deficits.

Area of Science:

  • Neuro-ophthalmology
  • Vascular Neurology

Background:

  • Acute esotropia, stupor, and impaired upward gaze are complex neurological symptoms.
  • Understanding the underlying neurovascular causes is crucial for diagnosis and treatment.

Observation:

  • Three male patients presented with acute esotropia, stupor, and impaired upward gaze.
  • Vestibulo-ocular stimulation revealed immobility of the adducted eye.
  • Residual signs included upgaze paresis and convergence-retraction nystagmus.

Findings:

  • Neuroimaging identified lesions in the contralateral posterior thalamus in all affected individuals.
  • Clinical and radiographic data strongly correlate with infarction in the territory of the basilar-communicating (mesencephalic) artery.
  • Embolism to the superior aspect of the basilar artery is the presumed cause.

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Implications:

  • This study highlights the posterior thalamus as a critical area for ocular motor control and consciousness.
  • Findings suggest a specific mechanism for acute esotropia secondary to thalamic or midbrain ischemia.
  • Identifying embolism to the basilar artery is key for managing these acute neurological events.