Sustained downgaze deviation. Two cases without structural pretectal lesions

Severe conjugate downward eye deviation of several days' duration in a lethargic patient with subarachnoid hemorrhage and of several weeks' duration in a comatose patient with hypoxic encephalopathy occurred in the absence of structural pretectal lesions. Persisting downgaze in a stuporous or comatose patient does not necessarily indicate anatomic pretectal damage.