[Paralysis of downward gaze and chronic global amnesia as a result of a bilateral thalamo-subthalamic lesion].

A 47 year-old male was found in coma and upon awakening 36 hours later, he showed a selective paralysis of downward gaze and convergence associated to an intellectual impairment. He was euphoric, unconcerned, poorly attentive, and had a severe amnesia for both anterograde and retrograde material. CT scan and NMR demonstrated a bilateral lacunar lesion of thalamic and subthalamic paramedian region. Over the 5 years follow-up, behavioral, personality and amnestic changes remained. On the other hand, supranuclear gaze paralysis improved as documented by EOG recordings with persisting limitations in voluntary down movements amplitude and dramatic reduction of fast components velocity.