This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (3)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cerebrovascular Disease  • Neuro-ophthalmology  • Diagnosis  • Alert me on articles by topic  Social Bookmarking   What's this?

Kwang-Dong Choi, MD; Dae Soo Jung, MD, PhD; Ji Soo Kim, MD, PhD

Arch Neurol. 2004;61:417-422.

Background  Tonic inward and downward deviation of the eyes ("peering at the tip of the nose") is regarded as a unique feature of thalamic hemorrhage, but the mechanisms of this ocular finding remain obscure.

Objectives  To describe 4 patients who showed tonic inward and downward deviation of the eyes from brainstem or thalamic lesions and to discuss the possible mechanisms involved.

Design  Case report.

Setting  Secondary and tertiary referral hospitals.

Results  One patient developed alternating esotropia with downward ocular deviation from thalamic hemorrhage compressing the midbrain. Two patients showed multiple infarctions in the territory of the posterior circulation with or without the involvement of the thalamus. Another patient had lateral pontine hemorrhage extending up to the midbrain tegmentum. Ocular bobbing preceded or accompanied tonic ocular deviation in 3 patients.

Conclusions  Tonic inward and downward deviation of the eyes may develop in thalamic or brainstem lesions. Irritation or destruction of the neural structures involved in the vergence and vertical gaze may cause this ocular sign in mesodiencephalic lesions. Skew deviation and esotropia from abduction deficit may be involved in some patients. Ocular bobbing and tonic downward deviation may share a common pathogenesis.

From the Department of Neurology, Pusan National University School of Medicine, Pusan (Drs Choi and Jung) and College of Medicine, Seoul National University, Seoul National University Bundang Hospital (Dr Kim), Korea.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pearls and oy-sters of localization in ophthalmoparesis
Buracchio and Rucker
Neurology 2007;69:E35-E40.
ABSTRACT | FULL TEXT  

Patterns of ocular oscillation in oculopalatal tremor: Imaging correlations
Kim et al.
Neurology 2007;68:1128-1135.
ABSTRACT | FULL TEXT