Alemdar Murat, Kamaci Senol, Budak Faik
Department of Neurology, Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
J Neuroophthalmol. 2006 Sep;26(3):173-6. doi: 10.1097/01.wno.0000235588.18169.de.
We report on a 47-year-old-woman who developed sudden complete loss of vertical saccades, smooth pursuit, and vestibular eye movements bilaterally. MRI revealed a unilateral midbrain infarct involving the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) and the interstitial nucleus of Cajal (INC) and spared the posterior commissure (PC). The lesion is presumed to have interrupted the pathways involved in vertical gaze just before they decussate, inducing an anatomically unilateral but functionally bilateral lesion. Previous reports of bidirectional vertical gaze palsy have shown lesions involving the PC or both riMLFs. This case is the first to show that a unilateral lesion of the riMLF and the INC that spares the PC may cause complete bidirectional vertical gaze palsy.
我们报告了一名47岁女性，她双侧突然出现垂直扫视、平稳跟踪和前庭眼动完全丧失。磁共振成像（MRI）显示单侧中脑梗死，累及内侧纵束的嘴侧间质核（riMLF）和 Cajal间质核（INC），而后连合（PC）未受影响。据推测，该病变在垂直注视相关通路交叉之前将其中断，导致解剖学上单侧但功能上双侧的病变。既往关于双向垂直注视麻痹的报道显示病变累及后连合或双侧riMLF。本病例首次表明，riMLF和INC的单侧病变且后连合未受影响可导致完全性双向垂直注视麻痹。
