[Blepharospasm caused by bilateral paramedian thalamic infarction]

A 67 year-old woman developed a small infarct in the superficial anterior territory of the left middle cerebral artery, then 2 other successive infarcts in the left then right thalamic paramedian territories. Left thalamic infarct was associated with right hemiparesis and speech disorders of the subcortical type. The occurrence of the additional right thalamic infarct was associated with stupor, left hemiparesis and oppositional behavior. A severe blepharospasm and paralysis of convergence and vertical eye movements were also noted. Blepharospasm has been rarely reported with structural central nervous system lesions. An extensive literature review disclosed 2 other cases associated with thalamic paramedian infarcts and 2 additional cases described with other thalamic lesions. In all these cases, blepharospasm seems to have been due to lesions of the intralaminar and dorsomedian nuclei.