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J Neurol Neurosurg Psychiatry 67:696-697 doi:10.1136/jnnp.67.5.696
  • Letters to the editor

Lateral gaze synkinesis on downward saccade attempts with paramedian thalamic and midbrain infarct

  1. M VERSINO,
  2. F SIMONETTI,
  3. M G EGITTO,
  4. M CERONI,
  5. V COSI
  1. Fondazione IRCCS Istituto Neurologico C Mondino, Pavia, Italy
  2. Dipartimento Scienze Neurologiche
  3. Dipartimento di Informatica e Sistemistica
  4. Università di Pavia, Italy
  1. Dr Maurizio Versino, Dipartimento Scienze Neurologiche, Università di Pavia, Fondazione Istituto Neurologico C Mondino IRCCS, Via Palestro 3, 27100 Pavia, Italy. Telephone 0039 0382 380340; fax 0039 0382 380286; emailmversino{at}unipv.it
  1. M VERSINO,
  2. M CERONI,
  3. V COSI
  1. Fondazione IRCCS Istituto Neurologico C Mondino, Pavia, Italy
  2. Dipartimento Scienze Neurologiche
  3. Dipartimento di Informatica e Sistemistica
  4. Università di Pavia, Italy
  1. Dr Maurizio Versino, Dipartimento Scienze Neurologiche, Università di Pavia, Fondazione Istituto Neurologico C Mondino IRCCS, Via Palestro 3, 27100 Pavia, Italy. Telephone 0039 0382 380340; fax 0039 0382 380286; emailmversino{at}unipv.it
  1. G BELTRAMI
  1. Fondazione IRCCS Istituto Neurologico C Mondino, Pavia, Italy
  2. Dipartimento Scienze Neurologiche
  3. Dipartimento di Informatica e Sistemistica
  4. Università di Pavia, Italy
  1. Dr Maurizio Versino, Dipartimento Scienze Neurologiche, Università di Pavia, Fondazione Istituto Neurologico C Mondino IRCCS, Via Palestro 3, 27100 Pavia, Italy. Telephone 0039 0382 380340; fax 0039 0382 380286; emailmversino{at}unipv.it

    The symptoms of paramedian thalamic and midbrain infarct include ocular motor disturbances mainly in the vertical plane.1 We here describe a patient with the additional feature of an unusual horizontal eye movement synkinesis.

    (A) and (B) show a thalamomesencephalic ischaemic lesion, hyperintense in T2 weighted scans (SE, TR=2300 ms; TE=25 ms). The lesion involves the anteromedial portion of both thalami, but the right one to a larger exrtent. In the midbrain, the lesion is located around the Sylvian acqueduct, and symmetrically, but prevalently right sided, and involves the area that is located posteromedially with respect to both red nuclei. (C) Recording of the horizontal (upper tracing) and of the vertical (bottom tracing) movement recorded respectively from the left and right eye with the infrared reflection technique (Skalar, IRIS system) during an attempted downward saccade. The vertical tracing is flat, as the patient was unable to move his eyes downward. By contrast, the horizontal tracing shows a concomitant leftward saccade. At outset, both tracings show a blink artifact.

    A 60 year old overweight man, with diabetes and mild hypertension, suddenly fell into a coma that lasted for 4 hours and …