Complete ophthalmoplegia: an unusual sign of bilateral paramedian midbrain-thalamic infarction

Stroke. 2008 Apr;39(4):1355-7. doi: 10.1161/STROKEAHA.107.504761. Epub 2008 Feb 28.


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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Cerebral Infarction / complications*
  • Cerebral Infarction / pathology*
  • Diffusion Magnetic Resonance Imaging
  • Functional Laterality
  • Humans
  • Male
  • Mesencephalon / pathology
  • Middle Aged
  • Ophthalmoplegia / etiology*
  • Ophthalmoplegia / pathology*
  • Thalamus / pathology