Fascicular third nerve palsy with decreased vertical saccade velocity of the contralateral eye

Abstract

A 59-year-old patient with an ischemic right unilateral midbrain stroke is described who exhibited a complete right fascicular third nerve palsy and in addition a vertical gaze paresis. After six months the disturbance of the vertical gaze could be demonstrated by slow saccades of the contralateral left eye, whereas the right third nerve palsy had only moderately improved. The lesion in the medial part of the midbrain tegmentum could be well demonstrated on MRI. The authors conclude that vertical saccades may be selectively disturbed, leaving the range of the slow vertical eye movements intact; moreover, a unilateral midbrain lesion may be sufficient to disturb vertical gaze.

Key Words:

• third nerve palsy
• vertical saccades
• midbrain infarction