Convergence and divergence synkinesis: A recovery pattern in benign pontine hematoma

Convergence substitution in pontine tegmental hemorrhage: an observation with Frenzel goggles

We report a case in which convergence movement was substituted for bilateral horizontal gaze palsy due to a pontine tegmental hemorrhage. When visual fixation was suppressed with Frenzel goggles (FG), substituted convergence movements were prominent in our patient. The observation suggests that both vergence eye movements and horizontal gaze movements act synergistically and lesioning of the version system results in overactivity of the convergence system after a pontine hemorrhage. Furthermore, it may be worth using FG in the observation of substituted eye movements in patients with horizontal gaze palsy due to a pontine tegmental injury.

Bilateral medial medullary infarction with oculomotor disorders

BACKGROUND AND PURPOSE

We describe the first case of bilateral medial medullary infarction demonstrated by magnetic resonance imaging. We discuss the relation between this lesion and the oculomotor signs that were observed clinically.

CASE DESCRIPTION

A 71-year-old man initially presented with pure motor hemiparesis, which progressed to complete quadriplegia. He also developed nearly complete vertical and horizontal ophthalmoplegia. Magnetic resonance imaging revealed upper medial medullary infarctions bilaterally that extended to the pontomedullary junction.

CONCLUSIONS

We propose that the vertical oculomotor disorders resulted from involvement of the oculomotor system in the caudal brain stem, especially the caudal paramedian pontine reticular formations on both sides.