Failure of downward gaze: the site and nature of the lesion
G. M. Halmagyi, W. A. Evans and J. M. Hallinan
We report four patients with paralysis of downward gaze but with intact
upward gaze, including one with detailed clinico-pathological studies and
another with a focal computerized axial tomographic (CT) scan abnormality
confirming the presence of bilateral lesions of the dorsomedial red
nucleus, including the fasciculus retroflexus. It is suggested that sudden,
permanent selective failure of downward gaze accompanied by transient
disturbance of consciousness is an embolic syndrome of the posterior
thalamosubthalamic or rubral artery.
