| Abnormal vergence with upper brainstem infarcts: pseudoabducens palsy. | |
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MedLine Citation:
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PMID: 10932266 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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P Pullicino; N Lincoff; B T Truax |
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Publication Detail:
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Type: Case Reports; Journal Article; Review |
Journal Detail:
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Title: Neurology Volume: 55 ISSN: 0028-3878 ISO Abbreviation: Neurology Publication Date: 2000 Aug |
Date Detail:
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Created Date: 2000-08-21 Completed Date: 2000-08-21 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 352-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, State University of New York at Buffalo 14203, USA. ppullici@acsu.buffalo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Abducens Nerve Diseases
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etiology*,
pathology Aged Brain Stem Infarctions / complications*, pathology Convergence, Ocular* Female Humans Magnetic Resonance Imaging Male Middle Aged |
| Comments/Corrections | |
Comment In:
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Neurology. 2001 Feb 13;56(3):424-5
[PMID:
11271651
]
Neurology. 2001 Feb 13;56(3):424; author reply 424-5 [PMID: 11171922 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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