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Clinical and Radiological Correlation

José Biller, MD; Rita Shapiro, DO; Lawrence S. Evans, MD, PhD; Jeffrey R. Haag, MD; Michael Fine, MD

Arch Neurol. 1984;41(9):985-987.

Abstract
• We describe a patient with an isolated mesencephalic dorsal tegmental infarct affecting the oculomotor nuclear complex and medial longitudinal fasciculus, documented by high-resolution computed tomography, after undergoing percutaneous transluminal coronary artery angioplasty. Clinically, the patient exhibited bilateral ptosis, bilateral internuclear ophthalmoplegia, transient convergence retractory nystagmus, and minimal somnolence. We believe the combined clinical and radiological findings favor the presence of a caudal, dorsal, and paramedian embolic infarct in the territory of the paramedian branches of the mesencephalic artery as the most likely mechanism for these exceptional findings and correlate them with Warwick's scheme of the oculomotor subnuclei.

Author Affiliations
From the Departments of Neurology (Drs Biller and Shapiro), Ophthalmology (Drs Evans and Haag), and Radiology (Dr Fine), Loyola University Medical Center, Maywood, Ill. Dr Biller is now with the University of Iowa Hospitals and Clinics, Iowa City.

Footnotes
Accepted for publication Oct 13, 1983.

Reprint requests to Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 (Dr Biller).

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