Neurological Sciences

, Volume 34, Issue 9, pp 1683–1684 | Cite as

A case of midbrain infarction causing ipsilateral mydriasis, contralateral superior rectus palsy, and bilateral ptosis

  • Tsukasa SaitoEmail author
  • Asuka Asanome
  • Jun Sawada
  • Takayuki Katayama
  • Naoyuki Hasebe
Letter to the Editor

Dear Editor,

A 68-year-old woman who had been diagnosed with advanced pancreatic cancer was admitted to our hospital because of fluctuating consciousness disturbance. We made the diagnosis of Trousseau syndrome, because magnetic resonance imaging demonstrated multiple acute cerebral infarcts. She showed disorientation, perseveration, and sensory aphasia, but no pupillary or oculomotor disturbance. On the day after admission, her level of consciousness deteriorated suddenly. The neurological examination revealed left pupillary mydriasis, bilateral ptosis, and downward rotation of the right eye. Although we could not evaluate the extraocular muscle motility in much detail due to her consciousness disturbance, the right eyeball rotated downward in the primary position when we forcibly opened the bilateral drooping eyelids. Elevation paresis of the right eyeball was also observed during tests of Bell’s phenomenon and oculocephalic reflexes. In dim light, the right pupil was 3 mm in...


Midbrain infarction Ipsilateral mydriasis Bilateral ptosis Anisocoria Oculomotor nucleus 


Conflict of interest

We have no conflict of interest to declare.


  1. 1.
    Bienfang DC (1975) Crossing axons in the third nerve nucleus. Invest Ophthalmol 14:927–931PubMedGoogle Scholar
  2. 2.
    Kwon JH, Kwon SU, Ahn HS, Sung KB, Kim JS (2003) Isolated superior rectus palsy due to contralateral midbrain infarction. Arch Neurol 60:1633–1635PubMedCrossRefGoogle Scholar
  3. 3.
    Tsukamoto Y, Yamamoto M, Fuse T, Kimura M (2005) Isolated crossed superior rectus palsy in a midbrain infarction. Rinsho Shinkeigaku 45:445–448PubMedGoogle Scholar
  4. 4.
    Chen L, Maclaurin W, Gerraty RP (2009) Isolated unilateral ptosis and mydriasis from ventral midbrain infarction. J Neurol 256:1164–1165PubMedCrossRefGoogle Scholar
  5. 5.
    Castro O, Johnson LN, Mamourian AC (1990) Isolated inferior oblique paresis from brain-stem infarction. Perspective on oculomotor fascicular organization in the ventral midbrain tegmentum. Arch Neurol 47:235–237PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Tsukasa Saito
    • 1
    Email author
  • Asuka Asanome
    • 1
  • Jun Sawada
    • 1
  • Takayuki Katayama
    • 1
  • Naoyuki Hasebe
    • 1
  1. 1.Division of Neurology, Department of Internal MedicineAsahikawa Medical UniversityAsahikawaJapan

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