Vertical gaze palsy and selective unilateral infarction of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF).

AUTOR(ES)

Bogousslavsky, J

RESUMO

We report a clinico-pathological correlation study in a patient with basilar artery thrombosis, who developed tetraplegia and combined up- and downgaze palsy involving voluntary saccades and visually-guided movements, but sparing the oculocephalic responses. At necropsy, apart from bilateral infarction in the basis pontis, there was a single unilateral infarct selectively destroying the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) on the right. The posterior commissure and its nucleus, the nucleus of Cajal, the nucleus of Darkschewitsch and the pontine tegmentum were spared. We suggest that the unilateral riMLF lesion may have disrupted bilateral upgaze excitatory and inhibitory inputs and unilateral downgaze excitatory inputs. The functional anatomy of inhibitory and excitatory vertical gaze circuitry, which remains speculative, may explain why a unilateral lesion of the upper midbrain tegmentum may be sufficient to generate an upgaze palsy or a combined up- and downgaze palsy, while an isolated downgaze palsy requires bilateral lesions.

Documentos Relacionados

• Reflex vertical gaze and the medial longitudinal fasciculus
• Vertical supranuclear gaze palsy with secondary syphilis
• Vertical gaze palsy due to a resolving midbrain lesion.
• Rigidity and dorsiflexion of the neck in progressive supranuclear palsy and the interstitial nucleus of Cajal.
• Congenital horizontal gaze palsy and kyphoscoliosis.