Yokota J, Imai H, Mizuno Y, Hishii M, Ito M
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
No To Shinkei. 1994 Mar;46(3):291-5.
A 13-year-old boy complained of frequent headaches and diplopia on rightward gaze. A CT scan demonstrated hydrocephalus and a non-homogeneous enhancing mass in the pineal area, leading to a diagnosis of pineal tumor. The physical examination revealed no abnormalities. On neurological examination, there were a right homonymous hemianopsia and slight choked disc in both optic fundi. His right eye was slightly adducted on primary gaze. On right lateral gaze, his right eye could not move beyond the midline and showed gaze paretic nystagmus, whereas his left eye could move fully in all directions. The abducens palsy could be overcome by the oculocephalic maneuver or caloric test. Interestingly, his right eye could abduct when his left eye was covered. From these finding, this was labelled a supranuclear abducens palsy. The convergent nystagmus was observed. Rightward OKN (quick phase to right) of the right eye was abolished with and without the left eye covered, while leftward OKN of the right eye was preserved. Pursuit to right was disturbed. After removal of the tumor, the gaze palsies disappeared. It is postulated that the supranuclear lateral gaze palsy was caused by impairment of supranuclear control by involvement of lateral gaze pathways to gaze center coursing near the oculomotor nucleus.
一名13岁男孩主诉频繁头痛及向右注视时出现复视。CT扫描显示脑积水以及松果体区有一个不均匀强化的肿块，从而诊断为松果体肿瘤。体格检查未发现异常。神经系统检查发现有右侧同向性偏盲以及双眼底轻度视乳头水肿。他在第一眼位时右眼轻度内收。在向右外侧注视时，他的右眼不能超过中线并出现注视性麻痹性眼球震颤，而他的左眼可以向各个方向充分运动。外展神经麻痹可通过眼前庭反射或冷热试验克服。有趣的是，当遮盖他的左眼时，他的右眼可以外展。根据这些发现，这被标记为核上性外展神经麻痹。观察到了集合性眼球震颤。无论左眼是否遮盖，右眼向右的视动性眼震（快相向右）均消失，而右眼向左的视动性眼震保留。向右的跟踪运动受到干扰。肿瘤切除后，注视麻痹消失。据推测，核上性侧方注视麻痹是由于靠近动眼神经核的侧方注视通路参与了注视中枢的核上控制受损所致。
