Article

[Bilateral medial medullary infarction presenting as vertical gaze palsy].

Department of Brain and Nerve Science (Internal Medicine 3), Oita University Faculty of Medicine.
Rinsho shinkeigaku = Clinical neurology 02/2006; 46(1):45-9. pp.45-9
Source: PubMed

ABSTRACT A 79-year old man noticed paresthesia in all 4 limbs, quadriplegia and dysarthria, and then developed respiratory arrest requiring mechanical ventilation. After level of consciousness was improved, vertical gaze palsy, left hemifacial palsy (central type) and quadriplegia were noted. Brain magnetic resonance imaging (MRI) on day 9 revealed bilateral upper medial medullary infarction. In general, the vertical gaze center is thought to be present in the midbrain, including the rostral interstitial nucleus of the medial longitudinal fasciculus, posterior commissure and interstitial nucleus of Cajal. Few reports have described vertical gaze palsy due to medullary lesions. The upper medial medullary lesions, particularly the paramedian tract in the medulla, may have been responsible for vertical gaze palsy in this patient.

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Keywords

79-year old man
 
bilateral upper medial medullary infarction
 
Brain magnetic resonance imaging
 
Cajal
 
central type
 
dysarthria
 
hemifacial palsy
 
interstitial nucleus
 
mechanical ventilation
 
medial longitudinal fasciculus
 
medulla
 
medullary lesions
 
MRI
 
palsy
 
posterior commissure
 
rostral interstitial nucleus
 
upper medial medullary lesions
 

Mika Jikumaru