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The Site and Nature of the Lesion

G. Michael Halmagyi, MB; William A. Evans, MB; John M. Hallinan, MB

Arch Neurol. 1978;35(1):22-26.

Abstract
• We report four patients with paralysis of downward gaze but with intact upward gaze, including one with detailed clinicopathological 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.

Author Affiliations
From the Department of Neurology (Dr Halmagyi), and Radiology (Dr Hallinan), Royal Prince Alfred Hospital, and the Department of Pathology (Dr Evans), University of Sydney, Sydney, Australia.

Footnotes
Accepted for publication June 28, 1977.

Read in part before the Australasian Association of Neurologists, Melbourne, March 23-25, 1977.

Reprint requests to National Hospital, Queen Square, London WC1N 3BG, England (Dr Halmagyi).

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