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Contralateral Gaze Deviation With Supratentorial Hemorrhage: Three Pathologically Verified Cases

Contralateral Gaze Deviation With Supratentorial Hemorrhage: Three Pathologically Verified Cases Abstract Three patients with spontaneous supratentorial intracerebral hemorrhage had contralateral sustained conjugate gaze deviation. The autopsies disclosed large thalamic-basal ganglia hemorrhages whose caudal extension was limited to the midbrain. Current knowledge of oculomotor localization does not adequately explain this "wrong-side" gaze deviation, and the mechanism remains obscure. The present cases suggest that thalamic hemorrhage can produce contralateral gaze deviation without involving postdecussation horizontal oculomotor pathways. Contralateral gaze deviation is not a rare occurrence with deep supratentorial hemorrhages, and awareness of this confusing sign should assist in localizing intracerebral hematomas. References 1. Fisher CM: Some neuro-ophthalmological observations . J Neurol Neurosurg Psychiatry 30:383-392, 1967.Crossref 2. Plum F, Posner JB: The Diagnosis of Stuporand Coma , ed 2. Philadelphia, FA Davis Co, 1972, pp 48-49. 3. Carmel PW: Sympathetic deficits following thalamotomy . Arch Neurol 18:378-387, 1968.Crossref 4. Fisher CM: The neurological examination of the comatose patient . Acta Neurol Scand 45( (suppl 36) ):1-55, 1960. 5. Wagman IH, Mehler WRL: Physiology and anatomy of the cortico-oculomotor mechanism, in Brodal A, Pompeiano O (eds): Basic Aspects of Central Vestibular Mechanisms . Prog Brain Res 37:632-635, 1972. 6. Goebel HH, Komatsuzaki A, Bender MB, et al: Lesions of the pontine tegmentum and conjugate gaze paralysis . Arch Neurol 24:431-440, 1971.Crossref 7. Astruc J: Corticofugal connections of area 8 (frontal eye field) in Macaca mulatta . Brain Res 33:241-256, 1971.Crossref 8. Bender MB, Shanzer S: Oculomotor pathways defined by electric stimulation and lesions in the brainstem of monkey , in Bender MB (ed): The Oculomotor System . New York, Harper & Row Publishers, 1964, pp 81-140. 9. Nashold BS Jr: Ocular reactions from brain stimulation in conscious man , in Smith JL (ed): Neuro-Ophthalmology . Hallandale, Fla, Hoffman Publishing Co, 1971, vol 5, pp 92-103. 10. Smith JL, Nashold BS, Kreshon MJ: Ocular signs after stereotactic lesions in the pallidum and thalamus . Arch Ophthalmol 65:532-535, 1961.Crossref 11. Hassler R: Supranuclear structures regulating binocular eye and head movements . Bibl Ophthalmol 82:207-219, 1972. 12. Pasik P, Pasik T, Bender MB: The pretectal syndrome in monkeys: Disturbances of gaze and body posture . Brain 92:521-534, 1969.Crossref 13. Robinson DA: Eye movements evoked by collicular stimulation in the alert monkey . Vision Res 12:1795-1808, 1972.Crossref 14. Komatsuzaki A, et al: Effects of mesencephalic reticular formation lesions on optokinetic nystagmus . Exp Neurol 34:522-534, 1972.Crossref 15. Cogan DG: Neurologic significance of lateral conjugate deviation of the eyes on forced closure of the lids . Arch Ophthalmol 39:37-42, 1948.Crossref 16. Bender MB: Neuro-ophthalmology , in Baker AB, Baker LH (eds): Clinical Neurology . Harper & Row Publishers, 1973, p 63. 17. Hoyt WF, Daroff RB: Supranuclear disorders of ocular control systems in man: Clinical, anatomical, and physiological correlations , in Bach-y-Rita P, Collins CC (eds): The Control of Eye Movements . New York, Academic Press, 1971, pp 175-236. 18. Penfield W, Rasmussen T: The Cerebral Cortex of Man: A Clinical Study of Localization of Function . New York, The MacMillan Co, 1950, pp 68-69. 19. Penfield W, Jasper H: Epilepsy and the Functional Anatomy of the Human Brain . Boston, Little Brown & Co, 1954, pp 269-270, 370-371. 20. Hassler R, Dieckman G: Locomotor movements in opposite directions induced by stimulation of pallidum or of putamen . J Neurol Sci 8:189-195, 1968.Crossref 21. Hassler R: Spezifische und unspezifische Systeme des Menschlichen Zwischenhirns, in Bargmann W, Schade JP (eds): Lectures on the Diencephalon . Prog Brain Res 5:1-32, 1964. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Contralateral Gaze Deviation With Supratentorial Hemorrhage: Three Pathologically Verified Cases

Archives of Neurology , Volume 32 (2) – Feb 1, 1975

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1975.00490440069011
Publisher site
See Article on Publisher Site

Abstract

Abstract Three patients with spontaneous supratentorial intracerebral hemorrhage had contralateral sustained conjugate gaze deviation. The autopsies disclosed large thalamic-basal ganglia hemorrhages whose caudal extension was limited to the midbrain. Current knowledge of oculomotor localization does not adequately explain this "wrong-side" gaze deviation, and the mechanism remains obscure. The present cases suggest that thalamic hemorrhage can produce contralateral gaze deviation without involving postdecussation horizontal oculomotor pathways. Contralateral gaze deviation is not a rare occurrence with deep supratentorial hemorrhages, and awareness of this confusing sign should assist in localizing intracerebral hematomas. References 1. Fisher CM: Some neuro-ophthalmological observations . J Neurol Neurosurg Psychiatry 30:383-392, 1967.Crossref 2. Plum F, Posner JB: The Diagnosis of Stuporand Coma , ed 2. Philadelphia, FA Davis Co, 1972, pp 48-49. 3. Carmel PW: Sympathetic deficits following thalamotomy . Arch Neurol 18:378-387, 1968.Crossref 4. Fisher CM: The neurological examination of the comatose patient . Acta Neurol Scand 45( (suppl 36) ):1-55, 1960. 5. Wagman IH, Mehler WRL: Physiology and anatomy of the cortico-oculomotor mechanism, in Brodal A, Pompeiano O (eds): Basic Aspects of Central Vestibular Mechanisms . Prog Brain Res 37:632-635, 1972. 6. Goebel HH, Komatsuzaki A, Bender MB, et al: Lesions of the pontine tegmentum and conjugate gaze paralysis . Arch Neurol 24:431-440, 1971.Crossref 7. Astruc J: Corticofugal connections of area 8 (frontal eye field) in Macaca mulatta . Brain Res 33:241-256, 1971.Crossref 8. Bender MB, Shanzer S: Oculomotor pathways defined by electric stimulation and lesions in the brainstem of monkey , in Bender MB (ed): The Oculomotor System . New York, Harper & Row Publishers, 1964, pp 81-140. 9. Nashold BS Jr: Ocular reactions from brain stimulation in conscious man , in Smith JL (ed): Neuro-Ophthalmology . Hallandale, Fla, Hoffman Publishing Co, 1971, vol 5, pp 92-103. 10. Smith JL, Nashold BS, Kreshon MJ: Ocular signs after stereotactic lesions in the pallidum and thalamus . Arch Ophthalmol 65:532-535, 1961.Crossref 11. Hassler R: Supranuclear structures regulating binocular eye and head movements . Bibl Ophthalmol 82:207-219, 1972. 12. Pasik P, Pasik T, Bender MB: The pretectal syndrome in monkeys: Disturbances of gaze and body posture . Brain 92:521-534, 1969.Crossref 13. Robinson DA: Eye movements evoked by collicular stimulation in the alert monkey . Vision Res 12:1795-1808, 1972.Crossref 14. Komatsuzaki A, et al: Effects of mesencephalic reticular formation lesions on optokinetic nystagmus . Exp Neurol 34:522-534, 1972.Crossref 15. Cogan DG: Neurologic significance of lateral conjugate deviation of the eyes on forced closure of the lids . Arch Ophthalmol 39:37-42, 1948.Crossref 16. Bender MB: Neuro-ophthalmology , in Baker AB, Baker LH (eds): Clinical Neurology . Harper & Row Publishers, 1973, p 63. 17. Hoyt WF, Daroff RB: Supranuclear disorders of ocular control systems in man: Clinical, anatomical, and physiological correlations , in Bach-y-Rita P, Collins CC (eds): The Control of Eye Movements . New York, Academic Press, 1971, pp 175-236. 18. Penfield W, Rasmussen T: The Cerebral Cortex of Man: A Clinical Study of Localization of Function . New York, The MacMillan Co, 1950, pp 68-69. 19. Penfield W, Jasper H: Epilepsy and the Functional Anatomy of the Human Brain . Boston, Little Brown & Co, 1954, pp 269-270, 370-371. 20. Hassler R, Dieckman G: Locomotor movements in opposite directions induced by stimulation of pallidum or of putamen . J Neurol Sci 8:189-195, 1968.Crossref 21. Hassler R: Spezifische und unspezifische Systeme des Menschlichen Zwischenhirns, in Bargmann W, Schade JP (eds): Lectures on the Diencephalon . Prog Brain Res 5:1-32, 1964.

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 1975

References