We here present the second clinicopathologic study of a patient with paralysis of downward, but not upward gaze. The findings confirm that bilateral lesions medial and dorsal to the red nuclei cause the syndrome. Since bilateral lesions of the pretectum-posterior commissure have reliably produced paralysis of upward gaze it is likely that components for upward movement are concentrated in this region. This study indicates that components for down-ward movement pass (bilaterally) more ventro-caudally than those for upward gaze. Anatomic structures situated medialdorsal to the red nuclei (eg, fasciculus retroflexus) seem to be particularly important substrates mediating downward movement of the eyes. It is possible, but unlikely, that bilateral small lesions of the rostral Edinger-Westphal nuclei may contribute to the syndrome.
Jacobs L, Anderson PJ, Bender MB. The Lesions Producing Paralysis of Downward But Not Upward Gaze. Arch Neurol. 1973;28(5):319–323. doi:10.1001/archneur.1973.00490230055007
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