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Double depressor palsy caused by bilateral paramedian thalamic infarcts
  1. S Pal,
  2. E Ferguson,
  3. S A Madill,
  4. R Al-Shahi Salman
  1. Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
  1. Correspondence to Dr R Al-Shahi Salman, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; rustam.al-shahi{at}ed.ac.uk

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A 45-year-old woman with Coffin–Lowry syndrome, but without risk factors for cerebrovascular disease, awoke with double vision and unsteadiness on her feet. Examination revealed a skew deviation of the eyes and diplopia on downgaze due to a “double depressor” palsy of the inferior rectus and superior oblique muscles. Her gait was unsteady with a tendency to veer left. Brain computed tomography (CT) and MRI confirmed bilateral paramedian thalamic infarcts (figs 1, 2). CT angiogram of the aortic arch and extracranial and intracranial …

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