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PARTIAL OCULOMOTOR NERVE PALSY DUE TO MIDBRAIN LESION:CASE REPORT AND DISCUSSION ON ITS CHARACTERISTICS Naokatsu Saeki 1 , Yasuo Iwadate 1 , Hiroki Namba 1 , Masaru Odaki 1 1Department of Neurosurgery, Kawatetsu Chiba Hospital pp.335-339
Published Date 1988/4/1
DOI https://doi.org/10.11477/mf.1406206085
  • Abstract
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A case of partial oculomotor palsy due to mid-brain infarction is reported.

Case presentation : Fifty-one-year old man noted a sudden onset of double vision. He transiently presented right hemiparesis, right hemihypesthe-sia and cerebellar ataxia. The main symptom was the left oculomotor palsy selectively involving extraocular muscles (levator and pupil sparing), lasting for more than 6 months.

The CT scan showed localized and well demar-cated low-density areas at the left tegmentum of midbrain and left anteromedial thalamus, diag-nosed as lacunar infarction due to occulusion of paramedian perforators at the basilar bifurcation. This midbrain infarct was supposed to be re-sponsible for the partial oculomotor palsy.

Extramedullary compressive and ischemic lesions have been well-known main causes of partial oculo-motor palsy. This case, however, has empha-sized the importance of recognition of midbrain lesion as a causative location of the partial oculo-motor palsy.

While the anatomical elucidation of this infre-quent palsy is not sufficient, a topography of oculomotor nuclear complex in rhesus monkey proposed by Warwick, is worthwhile to correlate with midbrain oculomotor palsy in human cases. The pupil and levator sparing oculomotor palsy is most frequently caused by the laterally loca-lized lesion at the fascicular portion which ex-tends transversely at the midbrain tegmentum. This is the most likely lesion in this reported case.

It is reported, on the other hand, that the levator sparing type oculomotor palsy is caused by a paramedian lesion of rostral midbrain and pupil sparing type by caudal midbrain. These may be explainable by rostro-caudal extension of the nuclear complex.


Copyright © 1988, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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