Can't see down

Introduction Vertical gaze was paralyzed, and both the patient's random and reflexive vertical gaze disappeared. This was due to the upper apex of the anterior and posterior commissures, and the medial and dorsal infarction of the red nucleus caused the paralysis of the lower eye. If the latter half of the upper part of the hill is damaged, the two eyes cannot be seen.

Cause

The medial and dorsal infarction of the red nucleus. The midbrain is covered by the inner side of the cover with the descending fibers of the horizontal and vertical movements of the eyeball and the nucleus of the oculomotor nerve. The lesions are different and different complex eye signs may appear.

an examination

Related inspection

Brain CT examination, oculomotor examination, eye function examination, ophthalmologic examination

When the oculomotor nerve is completely paralyzed, there is a ptosis, an extraocular slant, an enlarged pupil, a reaction to light, and a disappearance of the regulatory response. The ocular external slant is caused by the loss of antagonism of the lateral rectus tendon and the lateral rectus muscle. The affected eye can't move up, down, or inward, but it can still move slightly outward, because the superior oblique muscle is still normal.

Differential diagnosis

The midbrain is covered by the inner side of the cover with the descending fibers of the horizontal and vertical movements of the eyeball and the nucleus of the oculomotor nerve. The lesions are different, and different complex eye signs may appear, which need to be identified.

1. Vertical gaze paralysis: the patient's random and reflex vertical gaze disappeared. This was due to the upper apex of the anterior cranial infarction and the posterior commissural infarction. The medial and dorsal infarction of the red nucleus caused the paralysis of the lower eye.

2, pseudo-Parinaud syndrome: is the most characteristic manifestation of nuclear damage, complete lateral oculomotor nerve paralysis with contralateral upper visual disorder. Confinement of the contralateral view is due to destruction of the rectus muscle on the lesion side.

3, two ptosis with vertical gaze disorder: nuclear damage, the lesion involving the oculomotor nucleus of the superior rectus nucleus, the inferior rectus nucleus and the upper nucleus, the inner rectus nucleus and the inferior oblique nucleus Relatively unaffected. Since the superior rectus nucleus and the inferior rectus muscle nucleus are located at the upper end of the oculomotor nucleus, they are first involved, and the nucleus of the iliac crest is singled, so some injuries will also cause the two ptosis to sag.

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