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  • Title: Complete ophthalmoplegia: an unusual sign of bilateral paramedian midbrain-thalamic infarction.
    Author: Thurtell MJ, Halmagyi GM.
    Journal: Stroke; 2008 Apr; 39(4):1355-7. PubMed ID: 18309144.
    Abstract:
    BACKGROUND AND PURPOSE: Complete ophthalmoplegia, the combination of bilateral ptosis with loss of all extraocular movements, is rarely a consequence of ischemic stroke. We describe 3 patients who had complete ophthalmoplegia as a manifestation of bilateral paramedian midbrain-thalamic infarction, and we discuss possible pathophysiologic mechanisms. Summary of Cases- Three patients presented with coma. All had complete ophthalmoplegia that initially persisted despite improvement or fluctuation in their other deficits. MRI revealed bilateral paramedian midbrain-thalamic infarction. Two patients died, with the ophthalmoplegia remaining unchanged before death. The surviving patient had a progressive improvement in ocular abduction but persisting third nerve and vertical gaze palsies. CONCLUSIONS: Complete ophthalmoplegia is an unusual sign of bilateral paramedian midbrain-thalamic infarction. The ophthalmoplegia could result from combined third nerve, pseudoabducens, and vertical gaze palsies.
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