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Vertical gaze ophthalmoplegia

Selective paralysis of downgaze

Departments of Pathology, Charles S. Kubik Laboratory of Neuropathology (Dr. Trojanowski) and Neurology (Dr. Wray), Massachusetts General Hospital.

A 58-year-old man developed a selective supranuclear paralysis of downgaze, which was repeatedly documented until it completely resolved after 6 weeks. At autopsy, there was a bilaterally symmetric old infarct in the mesodiencephalic region. In common with four previous similar reports, the lesion involved structures bordering the dorsomedial aspect of the red nucleus. This same region has been implicated in the control of vertical eye movements in recent neuroanatomic and physiologic experiments in nonhuman primates.

Address correspondence and reprint requests to Dr. Trojanowski, Departmet of Pathology, Division of Neuropathology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104.

Read before the Neuro-ophthalmological Pathology Symposium, San Francisco, February 16–17, 1979.

Supported in part by Grant No. NS11551 by the National Institute of Neurological and Communicative Disorders and Stroke, D.H.E.W. (Dr. Wray).

Accepted for publication September 6, 1979.

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