Document Detail

Abnormal vergence with upper brainstem infarcts: pseudoabducens palsy.
MedLine Citation:
PMID:  10932266     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Infarcts of the rostral brainstem often cause vertical gaze palsies but may also produce inappropriate convergence that manifests as pseudoabducens palsy and convergence-retraction nystagmus (CRN). Although the substrate for vergence has been defined in the monkey as lying dorsal and lateral to the oculomotor nucleus, the human homologue is unknown.
METHOD: - The authors reviewed the clinical features, ocular findings, and CT or MR lesions in seven patients with pseudoabducens palsy and "top-of-the-basilar" infarction. They reviewed the literature for infarcts causing pseudoabducens palsy or CRN with precise autopsy localization. The authors then mapped the location of the infarcts on anatomic templates.
RESULTS: The smallest MR infarct produced an ipsilateral pseudoabducens palsy and CRN, and was located just rostral to the oculomotor nucleus, near the midbrain-diencephalic junction. Two patients with only contralateral pseudoabducens palsy had both subthalamic and thalamic infarction. Four patients with bilateral pseudoabducens palsy had larger infarcts involving the midbrain. All patients with pseudoabducens palsy had upgaze palsy. Two patients with CRN from the literature had small infarcts near the midbrain-diencephalic junction at autopsy.
CONCLUSIONS: Lesions near the midbrain-diencephalic junction are important for the development of pseudoabducens palsy. Pseudoabducens palsy and CRN are probably both manifestations of abnormal vergence activity. Inhibitory descending pathways for convergence may pass through the thalamus and decussate in the subthalamic region.
P Pullicino; N Lincoff; B T Truax
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Neurology     Volume:  55     ISSN:  0028-3878     ISO Abbreviation:  Neurology     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-08-21     Completed Date:  2000-08-21     Revised Date:  2014-07-28    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  352-8     Citation Subset:  AIM; IM    
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MeSH Terms
Abducens Nerve Diseases / etiology*,  pathology
Brain Stem Infarctions / complications*,  pathology
Convergence, Ocular*
Magnetic Resonance Imaging
Middle Aged
Comment In:
Neurology. 2001 Feb 13;56(3):424; author reply 424-5   [PMID:  11171922 ]
Neurology. 2001 Feb 13;56(3):424-5   [PMID:  11271651 ]

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