A case of bilateral paramedian midbrain–thalamic infarction with complete ophthalmoplegia

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  • Complete ophthalmoplegiaを呈した中脳傍正中–両側視床梗塞の1例

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Abstract

<p>An 81-year-old woman was brought unconscious to our hospital. She showed bilateral ptosis with loss of all extraocular movements and complete ophthalmoplegia (CO). Following the head MRI revealing bilateral paramedian midbrain–thalamic infarction, a disorder of the oculomotor nucleus and pseudo abducens palsy (PAP) were diagnosed. Rehabilitation was initiated by an anticoagulant therapy; however, she succumbed because of non-occlusive mesenteric ischemia and aspiration pneumonia on day 21. Midbrain infarction with CO is rare and is characterized by PAP, which is abducens palsy in the absence of an actual abducens lesion. This clinical pathology is induced by the interruption of inhibitory vergence pathways. Furthermore, cases of midbrain-thalamic infarction with CO reportedly with a tendency of high mortality necessitate early understanding of the underlying pathology by the physicians. Also, precise informed consent should be provided to the patient when these characteristic findings are confirmed.</p>

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