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• CLINICA NEUROL, 46: 45−49, 2006
• Vol.46 No.1 contents

Case Report

Bilateral medial medullary infarction presenting as vertical gaze palsy

Mika Jikumaru, M.D.¹⁾, Teruaki Masuda, M.D.¹⁾, Hidetsugu Ueyama, M.D.¹⁾, Kunihiro Sannomiya, M.D.¹⁾* and Toshihide Kumamoto, M.D.¹⁾

¹⁾Department of Brain and Nerve Science (Internal Medicine 3), Oita University Faculty of Medicine
*Department of Neurology, Nagato Memorial Hospital

A 79-year old man noticed paresthesia in all 4 limbs, quadriplegia and dysarthria, and then developed respiratory arrest requiring mechanical ventilation. After level of consciousness was improved, vertical gaze palsy, left hemifacial palsy (central type) and quadriplegia were noted. Brain magnetic resonance imaging (MRI) on day 9 revealed bilateral upper medial medullary infarction. In general, the vertical gaze center is thought to be present in the midbrain, including the rostral interstitial nucleus of the medial longitudinal fasciculus, posterior commissure and interstitial nucleus of Cajal. Few reports have described vertical gaze palsy due to medullary lesions. The upper medial medullary lesions, particularly the paramedian tract in the medulla, may have been responsible for vertical gaze palsy in this patient.

(CLINICA NEUROL, 46: 45−49, 2006)
key words: medial medullary infarction, vertical gaze palsy, paramedian tract, vestibular nucleus

(Received: 21-Feb-05)