A case of midbrain infarction causing ipsilateral mydriasis, contralateral superior rectus palsy, and bilateral ptosis
Letter to the Editor
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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...
KeywordsMidbrain infarction Ipsilateral mydriasis Bilateral ptosis Anisocoria Oculomotor nucleus
Conflict of interest
We have no conflict of interest to declare.
© Springer-Verlag Italia 2012