양측 시상경색에 의한 양하전근 마비 = A Case of Double Depressor Palsy due to Bilateral Thalamic Infarction

다국어 초록 (Multilingual Abstract)

Purpose: We report a rare case of double depressor palsy after bilateral thalamus infarction. Case summary: A 47-year-old male presented with complaints of diplopia upon awakening. He had atrial fibrillation, mitral valve regurgitation, aortic valve regurgitation and a history of spleen infarction 1 year prior. His right eye was hypertrophic and right eye downgaze was limited unilaterally of equal degree in adduction and abduction. Right eye horizontal and upward movements were intact. Left eye movement was intact in all directions. Pupillary light reflex response and convergence test were normal. Nystagmus was not observed. The patient was diagnosed with double depressor palsy of the right eye. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain showed an old infarction of the left thalamus and diffusion MRI showed acute infarction of the right thalamus. The patient's daily warfarin dose was 2 mg and was increased to 5 mg with cilostazol 75 mg two times a day. Seven weeks later, the patient's ocular movement revealed near normal muscle action and, subjectively, the patient was diplopia-free. Conclusions: Double depressor palsy is a extremely rare disease and can be caused by bilateral thalamic infarction. J Korean Ophthalmol Soc 2014;55(11):1714-1720

참고문헌 (Reference)

1 Heubner, "Zur topographie der Ernährungsgabiete der einzelnen hirnarterien" 52 : 817-821, 1872

2 Aziz RN, "The posterior thalamoperforating artery (the main perforating trunk from P1) microsurgical study" 3 : 103-107, 1992

3 Jacobs L, "The lesions producing paralysis of downward but not upward gaze" 28 : 319-323, 1973

4 Percheron G, "The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular pathology" 205 : 1-13, 1973

5 Jacobs L, "Selective paralysis of downward gaze caused by bilateral lesions of the mesencephalic periaqueductal gray matter" 35 : 516-521, 1985

6 Duret H, "Recherches anatomiques sur la circulation de l'encéphale" 1 : 60-91, 1874

7 Castaigne P, "Paramedian thalamic and midbrain infarct: clinical and neuropathological study" 10 : 127-148, 1981

8 Green JP, "Paralysis of downgaze in two patients with clinical-radiologic correlation" 111 : 219-222, 1993

9 Pal S, "Neurological picture. Double depressor palsy caused by bilateral paramedian thalamic infarcts" 80 : 1328-1329, 2009

10 Sukh Que Park, "Morphological Characteristics of the Thalamoperforating Arteries" 대한신경외과학회 47 (47): 36-41, 2010

11 Saeki N, "Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis" 46 : 563-578, 1977

12 Lee WT, "Medical neuroanatomy" Korea medical books publisher 439-, 2008

13 Halmagyi GM, "Failure of downward gaze: the site and nature of the lesion" 35 : 22-26, 1978

14 Ozdemir N, "Down gaze palsy due to periaqueductal lesion diagnosed by magnetic resonance imaging" 209 : 225-227, 1995

15 Bae CS, "Core text of neuroanatomy" Ko Moon Sa 241-280, 1993

16 "Congress of pediatric ophthalmology and strabismus. Current concepts in strabismus" Naewae-haksool 281-319, 2013

17 Rosenbaum AL, "Clinical strabismus management:principles and surgical techniques" W.B. Saunders Company 223-, 1999

18 Kim JS, "Clinical neuro-ophthalmology" E-public 2010

19 Gentilini M, "Bilateral paramedian thalamic artery infarcts: report of eight cases" 50 : 900-909, 1987

20 Lazzaro NA, "Artery of percheron infarction:imaging patterns and clinical spectrum" 31 : 1283-1289, 2010

21 Shea YF, "Artery of Percheron infarction" 18 : 446.e1-2-, 2012

22 Westberg G, "Arteries of the basal ganglia" 5 : 581-596, 1966

23 George AE, "Anatomy of the thalamoperforating arteries with special emphasis on arteriography of the third ventricle: Part I" 124 : 220-230, 1975