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Oculomotor synkinesis following a midbrain stroke

From the Division of Neuro-ophthalmology, Departments of Neurology and Ophthalmology, University of Pennsylvania Medical Center, Philadelphia, PA.

Address correspondence and reprint requests to Dr. G.T. Liu, Division of Neuro-ophthalmology, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104-4283; e-mail: gliu{at}mail.med.upenn.edu

Article abstract—— A 33-year-old man developed a complete third nerve palsy in the setting of acute bacterial endocarditis. MRI revealed an ischemic stroke in the cerebral peduncle involving the third nerve fascicle. Subsequently, he was observed to have paradoxic elevation of the eyelid on adduction and downgaze. To the authors’ knowledge, this is the first demonstration of oculomotor synkinesis after an acquired, ischemic CNS lesion.