복합수평-수직1 ½증후군1례
A Case of Combined Horizontal and Vertical One-and-a-Half Syndromes
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A 65-year-old man presented with rightward gaze palsy of both eyes and adduction palsy of the right eye. Healso showed difficulty in downward gaze of the right eye and bilateral upward palsy. These findings were consis-tent with horizontal and vertical one-and-a-half syndrome. Brain MRI showed multiple infarctions in the rightparamedian thalamus, upper mesencephalon, and pons. The horizontal one-and-a-half syndrome originate fromthe unilateral pontine lesion that may involve the paramedian pontine reticular formation (PPRF) and the adjacentmedial longitudinal fasciculus (MLF) on the side of the complete gaze palsy. The vertical one-and-a-half syn-drome may be due to the thalamo-mesencephalic lesion affecting the efferent tracts of the rostral interstitial nucle-us of MLF (riMLF) for upgaze and the descending fibers to the ipsilateral inferior rectus subnucleus and contralat-eral superior oblique subnucleus. We report the concurrence of the two distinct syndromes, horizontal and verticalone-and-a-half, in a patient with multiple brainstem infarctions. 대한뇌졸중학회지제6권제1호2004년5월
Abstract
A 65-year-old man presented with rightward gaze palsy of both eyes and adduction palsy of the right eye. Healso showed difficulty in downward gaze of the right eye and bilateral upward palsy. These findings were consis-tent with horizontal and vertical one-and-a-half syndrome. Brain MRI showed multiple infarctions in the rightparamedian thalamus, upper mesencephalon, and pons. The horizontal one-and-a-half syndrome originate fromthe unilateral pontine lesion that may involve the paramedian pontine reticular formation (PPRF) and the adjacentmedial longitudinal fasciculus (MLF) on the side of the complete gaze palsy. The vertical one-and-a-half syn-drome may be due to the thalamo-mesencephalic lesion affecting the efferent tracts of the rostral interstitial nucle-us of MLF (riMLF) for upgaze and the descending fibers to the ipsilateral inferior rectus subnucleus and contralat-eral superior oblique subnucleus. We report the concurrence of the two distinct syndromes, horizontal and verticalone-and-a-half, in a patient with multiple brainstem infarctions. 대한뇌졸중학회지제6권제1호2004년5월