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Journal of Neurology

, Volume 231, Issue 1, pp 43–45 | Cite as

Upgaze palsy and monocular paresis of downward gaze from ipsilateral thalamo-mesencephalic infarction: a vertical “one-and-a-half” syndrome

  • J. Bogousslavsky
  • F. Regli
Original Investigations

Summary

A patient with an infarct limited to the paramedian thalamus and upper mesencephalon on the right side suffered a conjugate upgaze palsy associated with a monocular paresis of downward gaze in the ispsilateral eye (vertical “one-and-a-half” syndrome). This paresis involved tonic and phasic components. Vertical oculocephalic movements and conjugate horizontal gaze were normal. It is suggested that the unilateral lesion destroyed the fibres of the posterior commissure and the descending fibres to the ipsilateral subnucleus of the inferior rectus and contralateral subnucleus of the superior oblique just after they decussate, probably above the level of the third nerve nucleus. A complex disturbance of vertical gaze may be due to a unilateral thalamo-mesencephalic lesion.

Key words

Infarction, thalamo-mesencephalic Vertical “one-and-a-half” syndrome 

Zusammenfassung

Wir beschreiben einen Patienten mit einem Infarkt rechts paramedian im Thalamus und oberen Mesencephalon mit Blicklähmung nach oben und einer Parese nach unten nur ipsilateral. Betroffen waren sowohl die tonischen wie die phasischen Bewegungskomponenten. Die vertikalen okulocephalen Reflexe und der konjugierte horizontale Blick waren normal. Wir vermuten, daß die einseitige Läsion Fasern der hinteren Kommissur und abwärts führende Fasern zum ipsilateralen Kern des Rectus inferior und zum gegenseitigen Kern des Obliquus superior zerstörte kaudal ihrer Kreuzung, wahrscheinlich rostral des Nucleus oculomotorius. Eine komplexe Störung der vertikalen Blickbewegung kann auf eine einseitige thalamo-mesencephale Läsion hinweisen.

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Copyright information

© Springer-Verlag 1984

Authors and Affiliations

  • J. Bogousslavsky
    • 1
  • F. Regli
    • 1
  1. 1.Service de NeurologieCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

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