Transient supranuclear paresis of the abduction in viral encephalitis of the brainstem

Abstract

The supranuclear paresis of the abducens system, also known as posterior internuclear ophthalmoplegia of abduction, is a very rare disorder clinically characterized by unilateral or bilateral abduction paresis sometimes associated with nystagmus of the contralateral adducting eye, slowing of abduction saccades, and intact horizontal vestibulo-ocular reflex. Here, we report a 35-year-old woman who presented transient left side abduction deficit in conjunction, as the only symptom of self-limited viral encephalitis of the brainstem. Brain MRI including DWI and ADC maps showed an area of abnormal signal intensity in the mid-right ponto-mesencephalic junction. PCR analysis of cerebrospinal fluid showed an enterovirus infection. Spontaneous clinical recovery rapidly occurred 2 days after onset. The brainstem lesion was undetectable at 5-week brain MRI follow-up.

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References

  1. 1.

    Thömke F, Hopf HC (2001) Abduction paresis with rostral pontine and/or mesencephalic lesions: pseudoabducens palsy and its relation to the so-called posterior internuclear ophthalmoplegia of Lutz. BMC Neurol 1:4–12

    Article  PubMed  Google Scholar 

  2. 2.

    Remler BF, Leigh J (2008) Posterior internuclear ophthalmoplegia of Lutz revisited: report of a case associated with a midbrain lesion. In: Leigh RJ, Devereaux MW (eds) Advances in understanding mechanisms and treatment of infantile forms of nystagmus. Oxford University Press, pp 156–161

  3. 3.

    Baloh RV, Furman JM, Yee RD (1985) Dorsal midbrain syndrome: clinical and oculographic findings. Neurology 35:54–60

    CAS  PubMed  Google Scholar 

  4. 4.

    Pullicino P, Lincoff N, Truax BT (2000) Abnormal vergence with upper brainstem infarcts: pseudoabducens palsy. Neurology 55(3):352–358

    CAS  PubMed  Google Scholar 

  5. 5.

    Nolan MA, Craig ME, Lahra LL, Rawlinson WD, Prager PC, Williams GD, Bye AME, Andrews PI (2003) Survival after pulmonary edema due to enterovirus 71 encephalitis. Neurology 60:1651–1656

    CAS  PubMed  Google Scholar 

  6. 6.

    Büttner-Ennever JA, Büttner U, Cohen B, Baumgartner G (1982) Vertical gaze paralysis and the rostral interstitial nucleus of the medial longitudinal fasciculus. Brain 105:125–149

    Article  PubMed  Google Scholar 

  7. 7.

    Watanabe A, Kobashi T (2005) Lateral gaze disturbance due to cerebral microbleed in the medial lemniscus in the mid-pontine region: a case report. Neuroradiology 47:908–911

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Parvizi J, Damasio A (2003) Neuroanatomical correlates of brainstem coma. Brain 126:1524–1536

    Article  PubMed  Google Scholar 

  9. 9.

    Miller MJ, Mark LP, Ho KC, Haughton VM (1997) Anatomic relationship of the oculomotor nuclear complex and medial longitudinal fasciculus in the midbrain. AJNR Am J Neuroradiol 18:111–113

    CAS  PubMed  Google Scholar 

  10. 10.

    Buttner-Ennever JA (1981) Anatomy of medial rectus subgroup in the oculomotor nucleus of the monkey. In: Fuchs AF, Becker W (eds) Progress in oculomotor research. Elsevier/North Holland, Amsterdam, pp 247–252

    Google Scholar 

  11. 11.

    Clendaniel RA, Mays LE (1994) Characteristics of antidromically identified oculomotor internuclear neurons during vergence and versional eye movements. J Neurophysiol 71:1111–1127

    CAS  PubMed  Google Scholar 

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Correspondence to Alessandra Rufa.

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Rufa, A., Cerase, A., Annunziata, P. et al. Transient supranuclear paresis of the abduction in viral encephalitis of the brainstem. Neurol Sci 31, 653–655 (2010). https://doi.org/10.1007/s10072-010-0339-9

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Keywords

  • Supranuclear abduction palsy
  • Ponto-mesencephalic junction
  • Encephalitis
  • Benign
  • MRI-DW
  • Enterovirus