Vertical oculomotor apraxia and memory loss

A case of vertical oculomotor apraxia with severe memory loss and hypokinetic inertia is described in a 34-year-old woman who was taking oral contraceptives. The eye movement disorder was limited to paralysis of voluntary vertical saccades; pursuit movements, reflex eye movement, and horizontal saccades were normal. Random involuntary vertical saccades documented by electronystagmography qualified this as a true apraxia. Similar cases from the literature have in common involvement of both medial thalami, a localization supported in this case by distinctive abnormalities on CAT scan. The clinical course suggested acute infarction, possibly due to embolism, in a territory supplied by the thalamosubthalamic paramedian arteries.