Neurologic Image Received: May 28, 2015 Accepted: June 14, 2015 Published online: July 15, 2015
Eur Neurol 2015;74:60–61 DOI: 10.1159/000435954
Rare Presentation of Midbrain Infarction: Isolated Medial Rectus Palsy Eda Derle Ruhsen Öcal Seda Kibaroglu Ufuk Can Department of Neurology, School of Medicine, Baskent University, Ankara, Turkey
Key Words Oculomotor nerve · Medial rectus · Stroke · Diplopia
resolution was observed after 1 month. Medial rectus palsy is a rare presention of acute ischemic stroke and early neuroimaging is important to establish such lesions. © 2015 S. Karger AG, Basel
Abstract A 69-year-old woman presented with sudden onset of diplopia. In neurologic examination left medial rectus palsy without abduction nystagmus was detected. Brain magnetic resonance imaging revealed acute ischemic lesion in mesencephalon on diffusion-weighted images. Sponteneous
A 69-year-old woman with hypertension and diabetes mellitus was admitted to the hospital with sudden onset of diplopia and dizziness. Neurologic examination showed left adduction paresis, impaired convergence
a
b
d
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Fig. 1. Extra-ocular movements. Medial gaze was impaired in the left eye.
© 2015 S. Karger AG, Basel 0014–3022/15/0742–0060$39.50/0 E-Mail [email protected] www.karger.com/ene
Eda Derle, MD Department of Neurology School of Medicine, Baskent University Mareşal Fevzi Çakmak Cad. 10.sok No. 45, Ankara (Turkey) E-Mail edaderle @ hotmail.com
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e
Fig. 2. Magnetic resonance imaging (diffusion-weighted images):
diffusion-weighted imaging revealed acute ischemic lesion in the left paramedian midbrain.
References
1
2
Medial Rectus Palsy Due to Stroke
tor nerve palsy is a rare presentation of ischemic stroke [2, 3]. Early neuroimaging is important to establish the causative lesion, and diffusion-weighted imaging can be useful to detect ischemic nuclear lesions.
Disclosure Statement There is no conflict of interest to report.
Hommel M, Bogousslavsky J: The spectrum of vertical gaze palsy following unilateral brainstem stroke. Neurology 1991; 41: 1229– 1234. Kim JS, Kang JK, Lee SA, Lee MC: Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke. Stroke 1993;24:581–586.
Eur Neurol 2015;74:60–61 DOI: 10.1159/000435954
3
Lee HS, Yang TI, Choi KD, Kim JS: Teaching video neuroImage: isolated medial rectus palsy in midbrain infarction. Neurology 2008; 71:e64.
61
Downloaded by: Kungliga Tekniska Hogskolan 198.143.54.65 - 8/12/2015 3:37:39 AM
without involvement of pupil or other extra-ocular muscles on the left eye (fig. 1), and no abduction nystagmus on the right eye. Magnetic resonance imaging of the brain showed acute ischemic lesion in mesencephalon on diffusion-weighted images (fig. 2). Her complaints resolved completely within 1 month. Eye movement disorders can present as a sign of midbrain infarcts usually combined with other signs of brainstem dysfunction [1]. Isolated or predominant oculomo-
Eur Neurol 2015;74:60–61 DOI: 10.1159/000435954
Rare Presentation of Midbrain Infarction: Isolated Medial Rectus Palsy Eda Derle Ruhsen Öcal Seda Kibaroglu Ufuk Can Department of Neurology, School of Medicine, Baskent University, Ankara, Turkey
Key Words Oculomotor nerve · Medial rectus · Stroke · Diplopia
resolution was observed after 1 month. Medial rectus palsy is a rare presention of acute ischemic stroke and early neuroimaging is important to establish such lesions. © 2015 S. Karger AG, Basel
Abstract A 69-year-old woman presented with sudden onset of diplopia. In neurologic examination left medial rectus palsy without abduction nystagmus was detected. Brain magnetic resonance imaging revealed acute ischemic lesion in mesencephalon on diffusion-weighted images. Sponteneous
A 69-year-old woman with hypertension and diabetes mellitus was admitted to the hospital with sudden onset of diplopia and dizziness. Neurologic examination showed left adduction paresis, impaired convergence
a
b
d
c
Fig. 1. Extra-ocular movements. Medial gaze was impaired in the left eye.
© 2015 S. Karger AG, Basel 0014–3022/15/0742–0060$39.50/0 E-Mail [email protected] www.karger.com/ene
Eda Derle, MD Department of Neurology School of Medicine, Baskent University Mareşal Fevzi Çakmak Cad. 10.sok No. 45, Ankara (Turkey) E-Mail edaderle @ hotmail.com
Downloaded by: Kungliga Tekniska Hogskolan 198.143.54.65 - 8/12/2015 3:37:39 AM
e
Fig. 2. Magnetic resonance imaging (diffusion-weighted images):
diffusion-weighted imaging revealed acute ischemic lesion in the left paramedian midbrain.
References
1
2
Medial Rectus Palsy Due to Stroke
tor nerve palsy is a rare presentation of ischemic stroke [2, 3]. Early neuroimaging is important to establish the causative lesion, and diffusion-weighted imaging can be useful to detect ischemic nuclear lesions.
Disclosure Statement There is no conflict of interest to report.
Hommel M, Bogousslavsky J: The spectrum of vertical gaze palsy following unilateral brainstem stroke. Neurology 1991; 41: 1229– 1234. Kim JS, Kang JK, Lee SA, Lee MC: Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke. Stroke 1993;24:581–586.
Eur Neurol 2015;74:60–61 DOI: 10.1159/000435954
3
Lee HS, Yang TI, Choi KD, Kim JS: Teaching video neuroImage: isolated medial rectus palsy in midbrain infarction. Neurology 2008; 71:e64.
61
Downloaded by: Kungliga Tekniska Hogskolan 198.143.54.65 - 8/12/2015 3:37:39 AM
without involvement of pupil or other extra-ocular muscles on the left eye (fig. 1), and no abduction nystagmus on the right eye. Magnetic resonance imaging of the brain showed acute ischemic lesion in mesencephalon on diffusion-weighted images (fig. 2). Her complaints resolved completely within 1 month. Eye movement disorders can present as a sign of midbrain infarcts usually combined with other signs of brainstem dysfunction [1]. Isolated or predominant oculomo-
