Vertical gaze ophthalmoplegia from infarction in the area of the posterior thalamo-subthalamic paramedian artery.

Three cases of a stroke syndrome of acute supranuclear vertical gaze ophthalmoplegia are presented. Voluntary vertical gaze and the vertical vestibulo-ocular reflex were absent or diminished initially in all three patients. The patients also had loss of convergence and alteration in their mental status. Computed tomography scans showed lesions in the region of the rostral midbrain and lower diencephalon in the area surrounding the third ventricle. The blood supply, ischemic stroke syndrome and function of this region with reference to the supranuclear control of vertical gaze are discussed.