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Arch Neurol. 2004;61:280.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A 51-year-old woman with a history of a heart murmur and a small stroke several years earlier suddenly began walking unsteadily and noticed vertical double vision. Examination findings revealed limitation of the right eye on looking down and in (Figure 1) and mild ataxia of gait and of each arm. She had a slight spontaneous left head tilt, and additional left tilt decreased, whereas right head tilt maximized image separation, supporting the diagnosis of a right trochlear nerve palsy. Magnetic resonance image findings showed bilateral cerebellar and left pontomesencephalic tectal infarctions in the territory of the superior cerebellar arteries (SCAs) (Figure 1). Echocardiography revealed a large atrial septal defect as the avenue of a probable paradoxical embolus. During the next 2 weeks, diplopia disappeared and ataxia improved.

Figure appears in full text version. A, Limitation of the right superior oblique muscle on gaze down and left. B, Magnetic resonance image (FLAIR [fluid-attenuated . . . [Full Text of this Article]

COMMENT

James R. Keane, MD
Department of Neurology, Room 5441
LAC/USC Medical Center
1200 N State St
Los Angeles, CA 90028