Abstract
We report a unique neuroophthalmological syndrome consisting of vertical one-and-a-half
syndrome—resulting from a combination of supranuclear conjugate upgaze palsy associated
with left infranuclear (fascicular) third nerve involvement (Weber syndrome)—with
concomitant contralesional pseudo-abducens palsy. Magnetic resonance imaging confirmed
that this unusual clinical combination was the result of two infarcts one in the left
thalamomesencephalic junction and another affecting the left infrategmental paramedian
area of the rostral midbrain. We discuss the clinical topography of both neuroophthalmological
findings. This unusual neuroophthalmological finding has not been reported.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Parinaud's syndrome: electro-oculographic and anatomical analyses of six vascular cases with deductions about vertical gaze organization in the premotor structures.Brain. 1982; 105: 667-696
- Vertical gaze paralysis and the rostral interstitial nucleus of the medial longitudinal fasciculus.Brain. 1982; 105: 125-149
- Supranuclear and internuclear ocular motility disorders.in: Miller N.R. Newman N.J. 6th ed. Walsh and Hoyt's clinical neuroophthalmolog. vol. 1. Baltimore, MD, William and Wilkins2005: 907-967
- Brain control of conjugate horizontal and vertical eye movements: a survey of the structural and functional correlates.Brain. 1980; 103: 23-69
- A clinicopathologic study of vertical eye movements.Arch Neurol. 1974; 31: 1-8
- Isolated and combined pareses of cranial nerves III, IV and VI: a retrospective study of 412 patients.J Neurol Sci. 1991; 103: 10-15
- Vertical one-and-a-half syndrome. Supranuclear downgaze paralysis with monocular elevation palsy.Arch Neurol. 1989; 46: 1361-1363
- Upgaze palsy and monocular paresis of downward gaze from ipsilateral thalamo-mesencephalic infarction: a vertical "one-and-a-half" syndrome.J Neurol. 1984; 231: 43-45
- The spectrum of vertical gaze palsy following unilateral brainstem stroke.Neurology. 1991; 41: 1229-1234
- Midbrain disorders of vertical gaze: a quantitative re-evaluation.Ann N Y Acad Sci. 2002; 956: 143-154
- Upbeat nystagmus and the ventral tegmental pathway of the upward vestibulo-ocular reflex.Neurology. 1988; 38: 1329-1330
- Chapter 39: neuro-ophthalmology: ocular motor system.in: Bradley W.G. Daroff R.B. Fenichel G. Jankovic J. Neurology in clinical practice. 4th ed. Butterworth-Heinemann, Oxford, UK2003: 721-726
- Abnormal vergence with upper brainstem infarcts: pseudoabducens palsy.Neurology. 2000; 55: 352-358
- Monocular ophthalmoplegia and partial supranuclear vertical gaze palsy due to unilateral paramedian rostral midbrain infarction.J Neurol. 2009; 256: 664-666
- Midbrain-diencephalic horizontal gaze paresis.J Clin Neuroophthalmol. 1987; 7: 227-234
- The prefrontal cortico-oculomotor trajectories in the monkey.J Neurol Sci. 1981; 49: 387-396
- Characteristics of antidromically identified oculomotor internuclear neurons during vergence and versional eye movements.J Neurophysiol. 1994; 71: 1111-1127
- Specificity of "peering at the tip of the nose" for a diagnosis of thalamic hemorrhage.Arch Neurol. 2004; 61: 417-422
- Paramedian thalamic and midbrain infarcts: clinical and neuropathological study.Ann Neurol. 1981; 10: 127-148
- “Top of the basilar” syndrome.Neurology. 1980; 30: 72-79
Article info
Publication history
Published online: September 14, 2011
Accepted:
August 23,
2011
Received in revised form:
July 30,
2011
Received:
May 11,
2011
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
