• Selective downgaze paralysis was correlated with discrete bilateral lesions at the mesencephalic-diencephalic junction in a 9-year-old girl following severe pneumococcal meningitis, and in a 64-year-old man who suffered an embolic infarction. Magnetic resonance imaging demonstrated bilateral lesions in the region of the rostral interstitial nucleus of the medial longitudinal fasciculus. Clinical-radiologic correlation allowed identification of the likely vascular cause in both patients.
Green JP, Newman NJ, Winterkorn JS. Paralysis of Downgaze in Two Patients With Clinical-Radiologic Correlation. Arch Ophthalmol. 1993;111(2):219-222. doi:10.1001/archopht.1993.01090020073026